Implications of the comparisons of age-related macular degeneration treatments trials on clinical practice: What have we learned?

Diana V. Do

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Topic: Discussion of Comparisons of Age-Related Macular Degeneration (AMD) Treatments Trials (CATT) results and the potential impact on neovascular AMD treatment. Clinical Relevance: Ranibizumab and bevacizumab are most commonly used for treatment of neovascular AMD. Although bevacizumab costs less, its use primarily has been based on retrospective studies without level 1 medical evidence. Thus, there was an unmet need to determine whether there is any difference in efficacy and safety between the 2 agents when used monthly or as needed (pro re nata [PRN]). Methods: Review of CATT (focusing on 1-year data because 2-year data were not released at the time of this symposium), a randomized clinical trial evaluating the efficacy and safety of monthly and PRN dosing of ranibizumab and bevacizumab. Results: At the 1-year primary end point, eyes that received monthly ranibizumab gained an average of 8.5 letters; those that received monthly bevacizumab gained a mean of 8 letters. Eyes randomized to PRN ranibizumab gained an average of 6.8 letters; those randomized to PRN bevacizumab gained a mean of 5.9 letters. In the pairwise comparisons, PRN bevacizumab compared with monthly bevacizumab and PRN bevacizumab compared with monthly ranibizumab both were found to be inconclusive. At the 2-year end point, eyes that received monthly ranibizumab gained an average of 8.8 letters; those that received monthly bevacizumab gained a mean of 7.8 letters; those randomized to PRN ranibizumab gained an average of 6.7 letters; those randomized to PRN bevacizumab gained a mean of 5 letters. A higher rate of serious systemic adverse events also was detected among bevacizumab-treated subjects. Conclusions: The CATT demonstrated that PRN ranibizumab is equivalent to monthly ranibizumab at the 1-year primary outcome. Monthly bevacizumab also is equivalent to monthly ranibizumab at the 1-year end point. The 2-year data showed less visual acuity gain with PRN dosing of either drug than monthly dosing. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

Original languageEnglish (US)
Pages (from-to)S8-S10
JournalOphthalmology
Volume120
Issue number5 SUPPL.
DOIs
StatePublished - May 1 2013

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Macular Degeneration
Clinical Trials
Disclosure
Bevacizumab
Ranibizumab
Safety
Visual Acuity
Randomized Controlled Trials
Retrospective Studies

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Implications of the comparisons of age-related macular degeneration treatments trials on clinical practice : What have we learned? / Do, Diana V.

In: Ophthalmology, Vol. 120, No. 5 SUPPL., 01.05.2013, p. S8-S10.

Research output: Contribution to journalArticle

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title = "Implications of the comparisons of age-related macular degeneration treatments trials on clinical practice: What have we learned?",
abstract = "Topic: Discussion of Comparisons of Age-Related Macular Degeneration (AMD) Treatments Trials (CATT) results and the potential impact on neovascular AMD treatment. Clinical Relevance: Ranibizumab and bevacizumab are most commonly used for treatment of neovascular AMD. Although bevacizumab costs less, its use primarily has been based on retrospective studies without level 1 medical evidence. Thus, there was an unmet need to determine whether there is any difference in efficacy and safety between the 2 agents when used monthly or as needed (pro re nata [PRN]). Methods: Review of CATT (focusing on 1-year data because 2-year data were not released at the time of this symposium), a randomized clinical trial evaluating the efficacy and safety of monthly and PRN dosing of ranibizumab and bevacizumab. Results: At the 1-year primary end point, eyes that received monthly ranibizumab gained an average of 8.5 letters; those that received monthly bevacizumab gained a mean of 8 letters. Eyes randomized to PRN ranibizumab gained an average of 6.8 letters; those randomized to PRN bevacizumab gained a mean of 5.9 letters. In the pairwise comparisons, PRN bevacizumab compared with monthly bevacizumab and PRN bevacizumab compared with monthly ranibizumab both were found to be inconclusive. At the 2-year end point, eyes that received monthly ranibizumab gained an average of 8.8 letters; those that received monthly bevacizumab gained a mean of 7.8 letters; those randomized to PRN ranibizumab gained an average of 6.7 letters; those randomized to PRN bevacizumab gained a mean of 5 letters. A higher rate of serious systemic adverse events also was detected among bevacizumab-treated subjects. Conclusions: The CATT demonstrated that PRN ranibizumab is equivalent to monthly ranibizumab at the 1-year primary outcome. Monthly bevacizumab also is equivalent to monthly ranibizumab at the 1-year end point. The 2-year data showed less visual acuity gain with PRN dosing of either drug than monthly dosing. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.",
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