Avastin does it again

Intravitreal Avastin (bevacizumab) is safe and effective, even after multiple treatments in patients with neovascular age-related macular degeneration (AMD), according to a study reported at the Association for Research in Vision and Ophthalmology (ARVO) annual meeting in Florida earlier this month.

Once again, Avastin is stealing the headlines and ARVO's annual meeting was no exception. A study in 81 eyes of 79 patients, conducted by Dante Pieramici, MD, co-director of California Retina and Research Foundation, Santa Barbara, California, US, found the controversial agent to elicit no safety concerns when administered intravitreally (1.25 mg dose) on a monthly basis, until macular oedema, pigment epithelial detachment or subretinal fluid resolution had been achieved.

Although the off-label use of Avastin is still highly controversial, treatment with the agent is apparently commonplace in at least 70 centres of 12 countries. Pieramici impressed his audience by stating that a reduction in macular oedema was apparent in some patients as little as six hours after the first injection, while a decrease of at least 10% in retinal thickness was seen in 55% of patients after one week of treatment. During follow-up periods, bevacizumab yielded more promising results, with 30 of 81 eyes demonstrating complete resolution of retinal oedema, subretinal fluid build-up and pigment epithelial detachment, at one-month. Complete resolution was achieved in a further 25 eyes at the two-month follow-up period, while improvements in visual acuity were evident in most patients by this time.

Although treatment with the agent was ineffective in 15 patients, it did appear to be safe, with only one reported case of unusual uveitis in a patient who had already received four injections.

Although Pieramici was impressed with the results of his study, he conceded that, although he had performed more than 400 procedures with bevacizumab himself, he was still uncertain of the optimum dose or of the agent's true influence on visual acuity.

Although further research clearly needs to be conducted with this agent, in this particular study, bevacizumab was administered to patients who had already undergone previous treatments with either photodynamic therapy and/or pegaptanib sodium. Hence, in conclusion, Pieramici stated that bevacizumab could offer AMD patients the last chance of halting the progress of their AMD when other treatments are not successful.