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Ranibizumab and Bevacizumab for Treatment of Neovascular Age-related Macular Degeneration: Two-Year Results.

Publication ,  Journal Article
Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group, ; Writing Committee:, ; Martin, DF; Maguire, MG; Fine, SL ...
Published in: Ophthalmology
April 2020

OBJECTIVE: To describe effects of ranibizumab and bevacizumab when administered monthly or as needed for 2 years and to describe the impact of switching to as-needed treatment after 1 year of monthly treatment. DESIGN: Multicenter, randomized clinical trial. PARTICIPANTS: Patients (n = 1107) who were followed up during year 2 among 1185 patients with neovascular age-related macular degeneration who were enrolled in the clinical trial. INTERVENTIONS: At enrollment, patients were assigned to 4 treatment groups defined by drug (ranibizumab or bevacizumab) and dosing regimen (monthly or as needed). At 1 year, patients initially assigned to monthly treatment were reassigned randomly to monthly or as-needed treatment, without changing the drug assignment. MAIN OUTCOME MEASURES: Mean change in visual acuity. RESULTS: Among patients following the same regimen for 2 years, mean gain in visual acuity was similar for both drugs (bevacizumab-ranibizumab difference, -1.4 letters; 95% confidence interval [CI], -3.7 to 0.8; P = 0.21). Mean gain was greater for monthly than for as-needed treatment (difference, -2.4 letters; 95% CI, -4.8 to -0.1; P = 0.046). The proportion without fluid ranged from 13.9% in the bevacizumab-as-needed group to 45.5% in the ranibizumab monthly group (drug, P = 0.0003; regimen, P < 0.0001). Switching from monthly to as-needed treatment resulted in greater mean decrease in vision during year 2 (-2.2 letters; P = 0.03) and a lower proportion without fluid (-19%; P < 0.0001). Rates of death and arteriothrombotic events were similar for both drugs (P > 0.60). The proportion of patients with 1 or more systemic serious adverse events was higher with bevacizumab than ranibizumab (39.9% vs. 31.7%; adjusted risk ratio, 1.30; 95% CI, 1.07-1.57; P = 0.009). Most of the excess events have not been associated previously with systemic therapy targeting vascular endothelial growth factor (VEGF). CONCLUSIONS: Ranibizumab and bevacizumab had similar effects on visual acuity over a 2-year period. Treatment as needed resulted in less gain in visual acuity, whether instituted at enrollment or after 1 year of monthly treatment. There were no differences between drugs in rates of death or arteriothrombotic events. The interpretation of the persistence of higher rates of serious adverse events with bevacizumab is uncertain because of the lack of specificity to conditions associated with inhibition of VEGF. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Duke Scholars

Published In

Ophthalmology

DOI

EISSN

1549-4713

Publication Date

April 2020

Volume

127

Issue

4S

Start / End Page

S135 / S145

Location

United States

Related Subject Headings

  • Wet Macular Degeneration
  • Visual Acuity
  • Vascular Endothelial Growth Factor A
  • Treatment Outcome
  • Tomography, Optical Coherence
  • Ranibizumab
  • Ophthalmology & Optometry
  • Middle Aged
  • Male
  • Intravitreal Injections
 

Citation

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Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group, ., Writing Committee:, ., Martin, D. F., Maguire, M. G., Fine, S. L., Ying, G.-S., … Ferris, F. L. (2020). Ranibizumab and Bevacizumab for Treatment of Neovascular Age-related Macular Degeneration: Two-Year Results. Ophthalmology, 127(4S), S135–S145. https://doi.org/10.1016/j.ophtha.2020.01.029
Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group, Frederick L., Frederick L. Writing Committee:, Daniel F. Martin, Maureen G. Maguire, Stuart L. Fine, Gui-Shuang Ying, Glenn J. Jaffe, et al. “Ranibizumab and Bevacizumab for Treatment of Neovascular Age-related Macular Degeneration: Two-Year Results.Ophthalmology 127, no. 4S (April 2020): S135–45. https://doi.org/10.1016/j.ophtha.2020.01.029.
Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group, Writing Committee:, Martin DF, Maguire MG, Fine SL, Ying G-S, et al. Ranibizumab and Bevacizumab for Treatment of Neovascular Age-related Macular Degeneration: Two-Year Results. Ophthalmology. 2020 Apr;127(4S):S135–45.
Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group, Frederick L., et al. “Ranibizumab and Bevacizumab for Treatment of Neovascular Age-related Macular Degeneration: Two-Year Results.Ophthalmology, vol. 127, no. 4S, Apr. 2020, pp. S135–45. Pubmed, doi:10.1016/j.ophtha.2020.01.029.
Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group, Writing Committee:, Martin DF, Maguire MG, Fine SL, Ying G-S, Jaffe GJ, Grunwald JE, Toth C, Redford M, Ferris FL. Ranibizumab and Bevacizumab for Treatment of Neovascular Age-related Macular Degeneration: Two-Year Results. Ophthalmology. 2020 Apr;127(4S):S135–S145.
Journal cover image

Published In

Ophthalmology

DOI

EISSN

1549-4713

Publication Date

April 2020

Volume

127

Issue

4S

Start / End Page

S135 / S145

Location

United States

Related Subject Headings

  • Wet Macular Degeneration
  • Visual Acuity
  • Vascular Endothelial Growth Factor A
  • Treatment Outcome
  • Tomography, Optical Coherence
  • Ranibizumab
  • Ophthalmology & Optometry
  • Middle Aged
  • Male
  • Intravitreal Injections