BRVO: Bevacizumab and Ranibizumab Both Effective

Lara C. Pullen, PhD

February 10, 2015

Patients with branch retinal vein occlusion (BRVO) who have been treated with either bevacizumab or ranibizumab experienced significant gain in visual acuity. Moreover, an as-needed dosing strategy was successful in maintaining the visual gain.

Raja Narayanan, MD, and colleagues from the L.V. Prasad Eye Institute in Hyderabad, India, published the results of their prospective, randomized trial online January 28 in the British Journal of Ophthalmology. The noninferiority trial was designed to determine whether bevacizumab was similar to ranibizumab.

The protocol used a strict set of spectral-domain optical coherence tomography–specified criteria to dictate treatment with ranibizumab (n = 37) or bevacizumab (n = 38). The investigators acknowledge that the pro-re-nata strategy may have limited improvements in visual acuity in both treatment groups.

They report that after the first injection, 16 eyes in each treatment group gained more than +15 letters of vision. At 6 months, the ranibizumab group had mean gains in best-corrected visual acuity of +18.1 letters (P < .0001; 95% confidence interval, +12.8 to +22.6 letters), and the bevacizumab group had mean gains in best-corrected visual acuity of +15.6 letters (P < .0001; 95% confidence interval, +12.0 to +20.5 letters).

Both drugs effectively reduced macular thickness and improved visual acuity. Thus, the two drugs appeared to be equally effective in the short term.

Typically, phase 3 trials for the treatment of macular edema caused by BRVO require monthly injections of ranibizumab or aflibercept. The results from this study suggest that pro-re-nata treatment may be just as effective as monthly injections, thereby allowing patients to receive a reduced number of treatments.

"The use of bevacizumab [off-label] for the treatment of retinal vein occlusions, macular degeneration, and diabetic retinopathy has been widespread both in the US and internationally since before there was an [US Food and Drug Administration]-approved drug for these indications, and continues today," explained Justin Townsend, MD, from the Bascom Palmer Eye Institute in Miami, Florida, to Medscape Medical News.

Laser photocoagulation was the standard therapy for macular edema resulting form BRVO, but it is now used as rescue treatment secondary to antivascular endothelial growth factor treatment. Bevacizumab is a less expensive antivascular endothelial growth factor than ranibizumab, and it is frequently used off-label to treat eye disease. Although a retrospective study has documented no differences between eyes with central retinal vein occlusion and BRVO treated with bevacizumab or ranibizumab, this is the first prospective, randomized study to address the question.

"This study is unique in being a well-executed head-to-head comparison of two drugs for retinal vein occlusion. While it is small, it confirms the general findings of larger head-to-head trials (in other retinal diseases) of the similar clinical efficacy of ranibizumab and off-label bevacizumab for many patients. This is in keeping with the typical clinical experience of the last 7 to 8 years," elaborated Dr Townsend.

More data should soon be available. "This is a very small study. There is a larger study ongoing right now: [Study of Comparative Treatments for Retinal Vein Occlusion 2] SCORE 2," Arun Singh, MD, from the Cleveland Clinic in Ohio, explained to Medscape Medical News. He explained that results of the National Institute of Health–funded study should provide physicians additional information they might need before making the decision to use bevacizumab off-label to treat macular edema resulting from BRVO.

"I would also caution and say that 6 months is a very short study period," added Dr Singh, referring to the results from the current study.

The authors, Dr Singh, and Dr Townsend have disclosed no relevant financial relationships.

Br J Ophthalmol. Published online January 28, 2015. Abstract

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