Bevacizumab for ocular neovascular diseases
a systematic review
Keywords:
Angiogenesis inhibitors, Retinal neovascularization, Corneal angiogenesis, Macular degeneration, ReviewAbstract
CONTEXT AND OBJECTIVE: Many eye diseases involve increased local levels of vascular endothelial growth factor (VEGF), and there are several therapeutic strategies for them. Thus, the aim of this study was to evaluate the effectiveness and safety of bevacizumab for treating eye diseases involving increased local levels of VEGF, as the assumed pathophysiological mechanism. DATA SOURCES: The following databases were systematically searched for evidence: PubMed, CENTRAL (Cochrane Library), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and reference lists, without language restrictions. Only randomized controlled trials were included. The primary outcome of interest was visual acuity, irrespective of the evaluation method. DATA SYNTHESIS: A total of 667 eyes in nine randomized trials were included. Meta-analysis showed that the proportion of patients with age-related macular degeneration who presented improvements from baseline regarding best-corrected visual acuity was higher among those treated with bevacizumab than among those in the photodynamic therapy group (risk ratio, RR, 0.49; 95% confidence interval, CI, 0.31 to 0.78; P = 0.01). CONCLUSIONS: The evidence available demonstrates that bevacizumab alone or combined with other treatments is more effective than other options, including photodynamic therapy, focal photocoagulation and triamcinolone. The use of bevacizumab instead of photodynamic therapy could reduce treatment costs by more than 99% and could significantly increase access to treatment. However, long-term studies are still needed in order to reduce uncertainty concerning the safety of this medication for all ocular neovascular diseases in which bevacizumab has the potential to improve visual acuity.
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References
Spaide RF. Rationale for combination therapies for choroidal neovascularization. Am J Ophthalmol. 2006;141(1):149-56.
Lee PP, Feldman ZW, Ostermann J, Brown DS, Sloan FA. Longitudinal prevalence of major eye diseases. Arch Ophthalmol. 2003;121(9):1303-10.
Strom BL, Carson JL, Halpern AC, et al. A population-based study of Stevens-Johnson syn- drome. Incidence and antecedent drug exposures. Arch Dermatol. 1991;127(6):831-8.
Ferrara N, Hillan KJ, Gerber HP, Novotny W. Discovery and development of bevacizumab, an anti-VEGF antibody for treating cancer. Nat Rev Drug Discov. 2004;3(5):391-400.
Grisanti S, Ziemssen F. Bevacizumab: off-label use in ophthalmology. Indian J Ophthalmol. 2007;55(6):417-20.
Bevacizumab (Avastin®) – Coverage for neovascular (Wet) macular degeneration. Cahaba GBA Medicare B Newsline. 2008. p. 11. Available from: https://www.cahabagba.com/ part_b/education_and_outreach/newsletters/2008/2008_03NL.pdf. Accessed in 2009 (Apr 15).
Neri P, Mariotti C, Mercanti L, Salvolini S, Giovannini A. Vitritis in the contralateral uninjected eye following intravitreal bevacizumab (Avastin). Int Ophthalmol. 2008;28(6):425-7.
Feinstein AR. An outline from cause-effect evaluations. In: Clinical Epidemiology: The Archi- tecture of Clinical Research. Philadelphia: WB Saunders; 1985. p. 39-52.
Review Manager (RevMan) [Computer program]. Version 5.0. Copenhagen: The Nordic Co- chrane Centre, The Cochrane Collaboration, 2007.
DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177- 88.
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539-58.
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557-60.
Vedula SS, Krzystolik MG. Antiangiogenic therapy with anti-vascular endothelial growth factor modalities for neovascular age-related macular degeneration. Cochrane Database Syst Rev. 2008;(2):CD005139.
Mirshahi A, Roohipoor R, Lashay A, Mohammadi SF, Abdoallahi A, Faghihi H. Bevacizumab- augmented retinal laser photocoagulation in proliferative diabetic retinopathy: a randomi- zed double-masked clinical trial. Eur J Ophthalmol. 2008;18(2):263-9.
Ahmadieh H, Ramezani A, Shoeibi N, et al. Intravitreal bevacizumab with or without triam- cinolone for refractory diabetic macular edema; a placebo-controlled, randomized clinical trial. Graefes Arch Clin Exp Ophthalmol. 2008;246(4):483-9.
Bashshur ZF, Schakal A, Hamam RN, El Haibi CP, Jaafar RF, Noureddin BN. Intravitreal beva- cizumab vs verteporfin photodynamic therapy for neovascular age-related macular degene- ration. Arch Ophthalmol. 2007;125(10):1357-61.
Diabetic Retinopathy Clinical Research Network, Scott IU, Edwards AR, et al. A phase II randomized clinical trial of intravitreal bevacizumab for diabetic macular edema. Ophthal- mology. 2007;114(10):1860-7.
Hahn R, Sacu S, Michels S, et al. Intravitreales Bevacizumab vs. Verteporfin und intravitre- ales Triamcinolon Acetonid bei Patienten mit neovaskulärer AMD [Intravitreal bevacizumab versus verteporfin and intravitreal triamcinolone acetonide in patients with neovascular age- related macula degeneration]. Ophthalmologe. 2007;104(7):588-93.
Lazic R, Gabric N. Verteporfin therapy and intravitreal bevacizumab combined and alone in choroidal neovascularization due to age-related macular degeneration. Ophthalmology. 2007;114(6):1179-85.
Paccola L, Costa RA, Folgosa MS, Barbosa JC, Scott IU, Jorge R. Intravitreal triamcinolone versus bevacizumab for treatment of refractory diabetic macular oedema (IBEME study). Br J Ophthalmol. 2008;92(1):76-80.
Soheilian M, Ramezani A, Bijanzadeh B, et al. Intravitreal bevacizumab (avastin) injection alone or combined with triamcinolone versus macular photocoagulation as primary treat- ment of diabetic macular edema. Retina. 2007;27(9):1187-95.
Tonello M, Costa RA, Almeida FP, Barbosa JC, Scott IU, Jorge R. Panretinal photocoagula- tion versus PRP plus intravitreal bevacizumab for high-risk proliferative diabetic retinopathy (IBeHi study). Acta Ophthalmol. 2008;86(4):385-9.
Weigert G, Michels S, Sacu S, et al. Intravitreal bevacizumab (Avastin) therapy versus pho- todynamic therapy plus intravitreal triamcinolone for neovascular age-related macular de- generation: 6-month results of a prospective, randomised, controlled clinical study. Br J Ophthalmol. 2008;92(3):356-60.
Fung AE, Rosenfeld PJ, Reichel E. The International Intravitreal Bevacizumab Safety Sur- vey: using the internet to assess drug safety worldwide. Br J Ophthalmol. 2006;90(11): 1344-9.
Moher D, Pham B, Jones A, et al. Does quality of reports of randomised trials affect es- timates of intervention efficacy reported in meta-analyses? Lancet. 1998;352(9128): 609-13.
Bakri SJ, Snyder MR, Reid JM, Pulido JS, Singh RJ. Pharmacokinetics of intravitreal bevacizu- mab (Avastin). Ophthalmology. 2007;114(5):855-9.
Steinbrook R. The price of sight--ranibizumab, bevacizumab, and the treatment of macular degeneration. N Engl J Med. 2006;355(14):1409-12.
Photodynamic therapy. Available from: http://www.mdsupport.org/library/photther.html. Accessed in 2009 (Apr 15).
Brown DM, Kaiser PK, Michels M, et al. Ranibizumab versus verteporfin for neovascular age- related macular degeneration. N Engl J Med. 2006;355(14):1432-44.
