Bevacizumab in age-related macular degeneration: a randomized controlled trial on the effect of on-demand therapy every 4 or 8weeks.

Abstract

Intravitreal anti-vascular endothelial growth factor (VEGF) injections are an effective treatment for neovascular age-related macular degeneration (nARMD). Bevacizumab appears to be a cost-effective off-label anti-VEGF alternative to ranibizumab, but an optimal injection schedule has not yet been determined. In this study, we investigate whether on-demand bevacizumab treatment every 8weeks is non-inferior to on-demand bevacizumab every 4weeks in treating nARMD. A total of 120 nARMD patients were randomly assigned to an on-demand regimen of intravitreal bevacizumab (IVB) every 4 (n=60) or 8weeks (n=60). The primary outcome was visual acuity (VA) change after 1year of treatment. Visual acuity (VA) improved between baseline and 1year in both treatment groups. The mean change in the VA score at 1year was not significantly different between bevacizumab administration on-demand every 4weeks [5.6±10.2 Early Treatment Diabetic Retinopathy Study (ETDRS) letter] or 8weeks (4.6±12.0 ETDRS letters). A reduction in the central retinal thickness was observed in both groups. At 1year, the mean decrease in central foveal thickness ranged from 61±90μm in the 4-week group to 91±83μm in the 8-week group (p=0.07). The mean number of IVB treatments during the study period was 8.7±2.3 in the 4-week group and 5.9±1.0 in the 8-week group. At 1year, bevacizumab administration on-demand every 8weeks was non-inferior to administration every 4weeks. The results strongly suggest that bevacizumab acts longer than 4weeks in ARMD, reducing the burden of injections for patients.