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Changing from bevacizumab to ranibizumab in age-related macular degeneration. Is it safe?  [cached]
Dimitrios A Karagiannis,Ioannis D Ladas,Efstratios Parikakis
Clinical Interventions in Aging , 2009,
Abstract: Dimitrios A Karagiannis1, Ioannis D Ladas2, Efstratios Parikakis1, Ilias Georgalas2, Athanasios Kotsolis2, Giorgos Amariotakis1, Vasileios Soumplis1, Panagiotis Mitropoulos11Ophthalmiatrio Eye Hospital of Athens, Athens, Greece; 2First Department of Ophthalmology, Medical School of Athens University, General Hospital of Athens, Athens, GreeceObjective: To report our experiences in changing from intravitreal bevacizumab to ranibizumab in age-related macular degeneration (AMD).Design: Retrospective case series.Participants and methods: We retrospectively reviewed the records of 34 patients (36 eyes) who were treated with monthly injections of intravitreal bevacizumab for six months and then switched to monthly injections of ranibizumab for 12 months. Best-corrected visual acuity measurements (BCVA), contact lens biomicroscopy, optical coherence tomography (OCT), and fluorescein angiography were performed at the baseline examination and then monthly. Chi-square test was used for statistical analysis.Results: Following bevacizumab treatment, retinal thickness decreased (P = 0.033) while BCVA improved (P = 0.040). Changing from bevacizumab to ranibizumab resulted in a transient decrease in BCVA (P = 0.045) and an increase in retinal thickness (P = 0.042). In addition, three eyes presented with a large subretinal hemorrhage. However, final retinal thickness was better than the initial thickness and the value following the bevacizumab course. No major ocular or systemic side effects were noted.Conclusions: Ranibizumab was clinically effective in the long term but the change of treatment from bevacizumab to a half-size molecule with less half-life in the vitreous such as ranibizumab contributed to a transient “instability” in the eye which may have triggered the large subretinal hemorrhage. There is insufficient experience reported in the literature in switching from one agent to another. A prospective study with controls is necessary to determine whether it is safe to change from one medication to another.Keywords: age-related macular degeneration, bevacizumab, ranibizumab, subretinal hemorrhage
Changing from bevacizumab to ranibizumab in age-related macular degeneration. Is it safe?
Dimitrios A Karagiannis, Ioannis D Ladas, Efstratios Parikakis, et al.
Clinical Interventions in Aging , 2009, DOI: http://dx.doi.org/10.2147/CIA.S8367
Abstract: nging from bevacizumab to ranibizumab in age-related macular degeneration. Is it safe? Original Research (4974) Total Article Views Authors: Dimitrios A Karagiannis, Ioannis D Ladas, Efstratios Parikakis, et al. Published Date November 2009 Volume 2009:4 Pages 457 - 461 DOI: http://dx.doi.org/10.2147/CIA.S8367 Dimitrios A Karagiannis1, Ioannis D Ladas2, Efstratios Parikakis1, Ilias Georgalas2, Athanasios Kotsolis2, Giorgos Amariotakis1, Vasileios Soumplis1, Panagiotis Mitropoulos1 1Ophthalmiatrio Eye Hospital of Athens, Athens, Greece; 2First Department of Ophthalmology, Medical School of Athens University, General Hospital of Athens, Athens, Greece Objective: To report our experiences in changing from intravitreal bevacizumab to ranibizumab in age-related macular degeneration (AMD). Design: Retrospective case series. Participants and methods: We retrospectively reviewed the records of 34 patients (36 eyes) who were treated with monthly injections of intravitreal bevacizumab for six months and then switched to monthly injections of ranibizumab for 12 months. Best-corrected visual acuity measurements (BCVA), contact lens biomicroscopy, optical coherence tomography (OCT), and fluorescein angiography were performed at the baseline examination and then monthly. Chi-square test was used for statistical analysis. Results: Following bevacizumab treatment, retinal thickness decreased (P = 0.033) while BCVA improved (P = 0.040). Changing from bevacizumab to ranibizumab resulted in a transient decrease in BCVA (P = 0.045) and an increase in retinal thickness (P = 0.042). In addition, three eyes presented with a large subretinal hemorrhage. However, final retinal thickness was better than the initial thickness and the value following the bevacizumab course. No major ocular or systemic side effects were noted. Conclusions: Ranibizumab was clinically effective in the long term but the change of treatment from bevacizumab to a half-size molecule with less half-life in the vitreous such as ranibizumab contributed to a transient “instability” in the eye which may have triggered the large subretinal hemorrhage. There is insufficient experience reported in the literature in switching from one agent to another. A prospective study with controls is necessary to determine whether it is safe to change from one medication to another.
Anterior uveitis after treatment of age-related macular degeneration with ranibizumab and bevacizumab: uncommon complication  [cached]
Damasceno N,Horowitz S,Damasceno E
Clinical Ophthalmology , 2012,
Abstract: Nadyr Damasceno,1 Soraya Horowitz,2 Eduardo Damasceno31,2Ophthalmology Department, Hospital Naval Marcilio Dias, Rio de Janeiro, Brazil; 3Department of Ophthalmology, Universidade Federal Fluminense, Niteroi, BrazilAbstract: The authors describe one case of anterior uveitis after treatment of age-related macular degeneration with both antiangiogenic drugs: ranibizumab and bevacizumab. The case is described as a complication of ranibizumab and bevacizumab due to an inflammatory process. Several reasons are suggested to explain this possibility, and the authors conclude that the main cause remains unknown.Keywords: antiangiogenic agent, complications, ocular inflammatory process, ranibizumab, bevacizumab, anterior uveitis
Bevacizumab versus Ranibizumab on As-Needed Treatment Regimen for Neovascular Age-Related Macular Degeneration in Turkish Patients  [PDF]
Abdullah Ozkaya,Zeynep Alkin,Yalcin Karakucuk,Dilek Yasa,Ahmet Taylan Yazici,Ahmet Demirok
ISRN Ophthalmology , 2013, DOI: 10.1155/2013/151027
Abstract: Purpose. To compare the efficacy of intravitreal bevacizumab versus ranibizumab in the treatment of neovascular age-related macular degeneration (nAMD). Methods. Retrospective, comparative study. The newly diagnosed nAMD patients who were treated with intravitreal bevacizumab or ranibizumab on an as-needed treatment regimen were included in the study. Main outcome measures were the change in best corrected visual acuity (BCVA), and central retinal thickness (CRT). Secondary outcome measures were the number of injections, and complications. Results. A total of 154 patients were included in the study. Bevacizumab group consisted of 79 patients, and ranibizumab group consisted of 74 patients. Mean follow-up time was 18.9 months, and 18.3 months in the bevacizumab and ranibizumab groups, respectively. There was not a significant difference between the two groups regarding the change in BCVA and CRT at all time points ( for all). The mean number of injections at month 12 was 4.8 and 4.7 in bevacizumab and ranibizumab groups, respectively ( ). No serious complications were detected in any of the groups. Conclusion. Both of the bevacizumab and ranibizumab found to be effective in the treatment of nAMD in regards of functional and anatomical outcomes with similar number of treatments and similar side effects. 1. Introduction Neovascular age-related macular degeneration (nAMD) is a leading cause of visual loss among elderly population [1, 2]. Before the introduction of intravitreal antivascular endothelial growth factor (anti-VEGF) agents for the treatment of nAMD, only prevention from visual acuity loss might have been achieved in a limited number of patients with different treatment options like laser photocoagulation, photodynamic therapy, and vitreoretinal surgery [3–9]. Intravitreal treatments with bevacizumab (full length antibody against VEGF-A) and ranibizumab (Fab part of antibody against VEGF-A) have led the majority of the patients to prevent the baseline visual acuity (VA) and even to achieve visual improvement in some of the patients [10, 11]. The multicenter studies with ranibizumab, like MARINA, ANCHOR, PRONTO, and EXCITE, and the comparative study of ranibizumab and bevacizumab, the CATT study, showed that ranibizumab and bevacizumab were effective to prevent VA loss up to 95% of the patients and is effective to make an improvement in VA up to 40% of the patients [11–15]. Today, the CATT trial answered the questions about the efficacy of bevacizumab versus ranibizumab and showed that both drugs had similar effects in the treatment of nAMD.
Anterior uveitis after treatment of age-related macular degeneration with ranibizumab and bevacizumab: uncommon complication
Damasceno N, Horowitz S, Damasceno E
Clinical Ophthalmology , 2012, DOI: http://dx.doi.org/10.2147/OPTH.S31239
Abstract: nterior uveitis after treatment of age-related macular degeneration with ranibizumab and bevacizumab: uncommon complication Case report (1487) Total Article Views Authors: Damasceno N, Horowitz S, Damasceno E Published Date July 2012 Volume 2012:6 Pages 1201 - 1205 DOI: http://dx.doi.org/10.2147/OPTH.S31239 Received: 27 February 2012 Accepted: 17 April 2012 Published: 31 July 2012 Nadyr Damasceno,1 Soraya Horowitz,2 Eduardo Damasceno3 1,2Ophthalmology Department, Hospital Naval Marcilio Dias, Rio de Janeiro, Brazil; 3Department of Ophthalmology, Universidade Federal Fluminense, Niteroi, Brazil Abstract: The authors describe one case of anterior uveitis after treatment of age-related macular degeneration with both antiangiogenic drugs: ranibizumab and bevacizumab. The case is described as a complication of ranibizumab and bevacizumab due to an inflammatory process. Several reasons are suggested to explain this possibility, and the authors conclude that the main cause remains unknown.
Bevacizumab vs ranibizumab for neovascular age-related macular degeneration in Chinese patients  [cached]
Jun Li,Han Zhang,Peng Sun,Feng Gu
International Journal of Ophthalmology , 2013, DOI: 10.3980/j.issn.2222-3959.2013.02.12
Abstract: AIM:To compare the clinical efficacy of intravitreal injections of bevacizumab and ranibizumab for treating Chinese patients with neovascular age-related macular degeneration (AMD). METHODS: Among 60 Chinese patients with exudative AMD (60 eyes), 28 received intravitreal bevacizumab injections (1.25mg) and 32 received intravitreal ranibizumab injections (0.5mg), once a month for 3 months and were followed for a total of 6 months. Monthly optical coherence tomography (OCT) was used to determine whether the patients received additional treatments during the follow-up. We compared the baseline and 6-month follow-up values of mean best-corrected visual acuity (BCVA) and central retinal thickness (CRT) in both groups of patients. We also compared the occurrence of adverse events. RESULTS:At the 6-month follow-up, the mean BCVA (logMAR) of the bevacizumab and ranibizumab treatment groups improved from the baseline measurements of 0.72±0.23 and 0.73±0.22 to 0.47±0.14 and 0.45±0.20, respectively (P<0.05 for both groups). However, the change was not significantly different between the two groups. As evaluated by OCT, CRT decreased from 366.71±34.72μm and 352±36.9μm at baseline to 250.86±41.51μm and 243.22±41.38μm in the bevacizumab and ranibizumab groups, respectively (P<0.05 for both groups). However, the change was not significantly different between the two groups. There were no severe local adverse reactions or systemic adverse events. CONCLUSION:Intravitreal bevacizumab and ranibizumab have equivalent effects on BCVA and CRT and appeare safe over the short-term.
Profile of ranibizumab: efficacy and safety for the treatment of wet age-related macular degeneration
Chen Y,Han F
Therapeutics and Clinical Risk Management , 2012,
Abstract: Youxin Chen, Fei HanDepartment of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, ChinaAbstract: Wet age-related macular degeneration (AMD) causes severe vision loss due to the development of choroidal neovascularization (CNV). The critical role of vascular endothelial growth factor in the pathogenesis of CNV is well understood. Ranibizumab plays an inhibitory role with CNV and reduces vascular permeability by binding to vascular endothelial growth factor. Intravitreal ranibizumab reduces the risk of visual acuity (VA) loss and increases the chance of VA gain compared with no treatment or photodynamic therapy for CNV in AMD. Some high-quality research has shown that the optimal timing for ranibizumab treating wet AMD is the first 3 months. It is recommended that ranibizumab is intravitreally injected monthly in the initiation for at least 3 months. Subsequent managing of regimens should be made dependent on the VA change, fundus examination, and image of optical coherence topography. An individualized strategy or combined method with photodynamic therapy is beneficial to the active lesion in the consecutive treatment of ranibizumab for CNV, and may be a good choice in order to decrease injection times. Regarding the safety profile, ranibizumab has been well tolerated in clinical trials. The principal ocular adverse event detected in clinical trials is a low frequency of ocular inflammation. Key serious ocular adverse events occurred in <5% of ranibizumab-treated patients in large-scale clinical trials. It appears unlikely that treatment with ranibizumab increases the risk of vascular events significantly. Less frequent injections on an as-needed schedule, based on monthly monitoring may have the most optimal risk:benefit ratio.Keywords: age-related macular degeneration, choroidal neovascularization, ranibizumab, efficacy, safety
Intravitreal ranibizumab and bevacizumab for the treatment of nonsubfoveal choroidal neovascularization in age-related macular degeneration
Roller, Aaron Brock;Amaro, Miguel Hage;
Arquivos Brasileiros de Oftalmologia , 2009, DOI: 10.1590/S0004-27492009000500016
Abstract: purpose: to investigate the efficacy of vascular endothelial growth factor-specific (vegf) monoclonal antibodies in the treatment of choroidal neovascularization secondary to age-related macular degeneration (amd) that does not extend beneath the foveal center (nonsubfoveal cnv). methods: the study design was a retrospective chart review of consecutive patients over a two-month period under active treatment with bevacizumab and/or ranibizumab for neovascular amd. patients with neovascularization within the macula that did not extend beneath the center of the foveal avascular zone, along with at least one large drusen (>125 μ) or many intermediate size (63-124 μ) drusen were included. best corrected snellen visual acuity and optical coherence tomography (oct) analysis of the central macular thickness was recorded for each visit. serial injections of bevacizumab and/or ranibizumab were administered until there was resolution of subretinal fluid clinically or by oct. data over the entire follow-up period were analyzed for overall visual acuity and oct changes. all patients had follow-up since diagnosis of at least 6 months (mean=9.6 months). results: of the thirteen included patients, eleven had reduction of retinal thickening in the area involved by the cnv. the remaining two patients did not have oct data available but had no fluid or activity on clinical examination at last follow-up. one patient (8%) lost one line of vision; one (8%) remained stable, and eleven (84%) gained one or more lines of visual acuity. three patients (23%) gained three or more lines. the average treatment outcome for all patients was a gain of 1.7 ± 1.3 lines of snellen acuity. both therapeutic agents were effective, with an average gain of 1.6 ± 0.6 lines for patients treated with bevacizumab, 1.5 ± 1.9 lines gained for patients treated with ranibizumab and 2.5 ± 0.7 lines gained in the two patients who received both agents over the course of their treatment. conclusions: the use of intravi
Profile of ranibizumab: efficacy and safety for the treatment of wet age-related macular degeneration
Chen Y, Han F
Therapeutics and Clinical Risk Management , 2012, DOI: http://dx.doi.org/10.2147/TCRM.S32801
Abstract: ofile of ranibizumab: efficacy and safety for the treatment of wet age-related macular degeneration Review (1473) Total Article Views Authors: Chen Y, Han F Published Date July 2012 Volume 2012:8 Pages 343 - 351 DOI: http://dx.doi.org/10.2147/TCRM.S32801 Received: 10 April 2012 Accepted: 14 May 2012 Published: 11 July 2012 Youxin Chen, Fei Han Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China Abstract: Wet age-related macular degeneration (AMD) causes severe vision loss due to the development of choroidal neovascularization (CNV). The critical role of vascular endothelial growth factor in the pathogenesis of CNV is well understood. Ranibizumab plays an inhibitory role with CNV and reduces vascular permeability by binding to vascular endothelial growth factor. Intravitreal ranibizumab reduces the risk of visual acuity (VA) loss and increases the chance of VA gain compared with no treatment or photodynamic therapy for CNV in AMD. Some high-quality research has shown that the optimal timing for ranibizumab treating wet AMD is the first 3 months. It is recommended that ranibizumab is intravitreally injected monthly in the initiation for at least 3 months. Subsequent managing of regimens should be made dependent on the VA change, fundus examination, and image of optical coherence topography. An individualized strategy or combined method with photodynamic therapy is beneficial to the active lesion in the consecutive treatment of ranibizumab for CNV, and may be a good choice in order to decrease injection times. Regarding the safety profile, ranibizumab has been well tolerated in clinical trials. The principal ocular adverse event detected in clinical trials is a low frequency of ocular inflammation. Key serious ocular adverse events occurred in <5% of ranibizumab-treated patients in large-scale clinical trials. It appears unlikely that treatment with ranibizumab increases the risk of vascular events significantly. Less frequent injections on an as-needed schedule, based on monthly monitoring may have the most optimal risk:benefit ratio.
Comparative study of 1+PRN ranibizumab versus bevacizumab in the clinical setting  [cached]
Carneiro AM,Mendonça LS,Falcão MS,Fonseca SL
Clinical Ophthalmology , 2012,
Abstract: Angela M Carneiro,1,2 Luis S Mendon a,1 Manuel S Falc o,1,2 Sofia L Fonseca,1 Elisete M Brand o,1 Fernando M Falc o-Reis1,21Department of Ophthalmology of Hospital de S o Jo o, Porto, Portugal; 2Faculty of Medicine of University of Porto, Porto, PortugalPurpose: We compared the efficacy of intravitreal ranibizumab and bevacizumab for treating neovascular age-related macular degeneration using an on-demand regimen.Methods: A total of 186 wet age-related macular degeneration eyes of 186 treatment-na ve patients were compared retrospectively (67 eyes treated with ranibizumab with 91 treated with bevacizumab). At baseline, mean age, best corrected visual acuity, and angiographic lesion types were similar in both groups. Best corrected visual acuity and ocular coherence tomography were evaluated.Results: Sixty eyes treated with ranibizumab and 85 eyes treated with bevacizumab completed a 12-month evaluation. At 12 months, mean best corrected visual acuity increased by +6.65 letters with ranibizumab treatment and by +5.59 with bevacizumab treatment (P = 0.64). Visual acuity improved by ≥15 letters in 15 eyes treated with ranibizumab and in 21 eyes treated with bevacizumab (P = 0.75). An overall reduction in ocular coherence tomography central thickness occurred for all time points. The mean number of injections per eye was 5.97 with ranibizumab and 5.92 with bevacizumab (P = 0.90).Conclusion: Intravitreal therapies with ranibizumab or bevacizumab have similar visual and anatomical results. These results confirm those of comparison of Age-Related Macular Degeneration Treatment Trials in as-needed cohorts in clinical practice. Randomized long-term clinical trials are necessary to examine the systemic safety of these treatments.Keywords: AMD, anti-VEGF therapy, bevacizumab, choroidal neovascularization, ranibizumab, wet AMD
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