A retrospective study of the use of intravitreal bevacizumab in a public hospital in Argentina

Authors

  • Alejo Martínez Peterlin Servicio de Oftalmología, Hospital Interzonal General de Agudos Prof. Dr. Rodolfo Rossi, La Plata, Buenos Aires, Argentina
  • Gustavo Pin Hidalgo Servicio de Oftalmología, Hospital Interzonal General de Agudos Prof. Dr. Rodolfo Rossi, La Plata, Buenos Aires, Argentina
  • Magalí Sansinanea Servicio de Oftalmología, Hospital Interzonal General de Agudos Prof. Dr. Rodolfo Rossi, La Plata, Buenos Aires, Argentina
  • Gonzalo Ariel Méndez Servicio de Oftalmología, Hospital Interzonal General de Agudos Prof. Dr. Rodolfo Rossi, La Plata, Buenos Aires, Argentina
  • Beatriz Berlatto Servicio de Oftalmología, Hospital Interzonal General de Agudos Prof. Dr. Rodolfo Rossi, La Plata, Buenos Aires, Argentina
  • Patricia Paglieri Servicio de Oftalmología, Hospital Interzonal General de Agudos Prof. Dr. Rodolfo Rossi, La Plata, Buenos Aires, Argentina
  • Florencia Settecase Servicio de Oftalmología, Hospital Interzonal General de Agudos Prof. Dr. Rodolfo Rossi, La Plata, Buenos Aires, Argentina
  • Diana Anzorena Servicio de Oftalmología, Hospital Interzonal General de Agudos Prof. Dr. Rodolfo Rossi, La Plata, Buenos Aires, Argentina
  • Luisa Poffer Servicio de Oftalmología, Hospital Interzonal General de Agudos Prof. Dr. Rodolfo Rossi, La Plata, Buenos Aires, Argentina
  • Felipe Crocco Servicio de Oftalmología, Hospital Interzonal General de Agudos Prof. Dr. Rodolfo Rossi, La Plata, Buenos Aires, Argentina
  • Andrea Valeiras Servicio de Oftalmología, Hospital Interzonal General de Agudos Prof. Dr. Rodolfo Rossi, La Plata, Buenos Aires, Argentina

DOI:

https://doi.org/10.70313/2718.7446.v17.n02.323

Keywords:

bevacizumab, intravitreal injections, retina, public health, off-label medication

Abstract

Objective: To describe the results obtained with the use of intravitreal injections of bevacizumab for vitreo-retinal pathologies.

Materials and methods: A single-center retrospective study examined the evolution of patients who received at least one intravitreal injection of bevacizumab between February 2021 and March 2024. Information was collected on age, sex, diagnosis, initial and final best-corrected visual acuity, change in at least 1 decimal place, compliance with the treatment schedule, reason for discontinuation of treatment, initial and final macular thickness, and serious adverse events.

Results: The study included 84 eyes of 77 patients with a mean age of 56.3 years (range: 23-89). A total of 218 injections were administered, with an average of 2.56 injections per eye and 2.8 per patient. The main pathologies treated were diabetic macular edema (34.52%) and macular edema secondary to vascular occlusions (33.3%). The primary scheme of 3 doses was complied with in 72.62% of the cases. An improvement in visual acuity was observed in 72.1% of patients, with an average macular thickness reduction of 110.74 µm. Serious adverse effects were infrequent, with a case of high blood pressure (0.4%) and one case of rhegmatogenous retinal detachment (0.4%).

Conclusion: Treatment with intravitreal injections of bevacizumab proved to be safe and effective in improving visual acuity in vitreoretinal pathologies, being also a cost-beneficial strategy in the context of public health.

References

Argentina. Comisión Nacional de Evaluación de Tecnologías de Salud (CONETEC). Bevacizumab en degeneración macular asociada a la edad. Buenos Aires: CONETEC, 2019. (Informe de evaluación de tecnologías sanitarias; 2). Disponible en https://www.argentina.gob.ar/sites/default/files/02-informe-bevacizumab_0.pdf

Grisanti S, Ziemssen F. Bevacizumab: off-label use in ophthalmology. Indian J Ophthalmol 2007, 55: 417-420.

American Academy of Ophthalmology (AAO). Age related macular degeneration. San Francisco: AAO, 2019. (Preferred practice pattern guidelines).

American Academy of Ophthalmology (AAO). Retinal vein occlusion. San Francisco: AAO, 2019. (Preferred practice pattern guidelines).

Barría von-Bischhoffshausen F, Martínez Castro F, Verdaguer Terradella J (eds.). Actualización de la guía clínica de retinopatía diabética para Latinoamérica: dirigida a oftalmólogos y profesionales de la salud. Pantego, Texas: Asociación Panamericana de Oftalmología (PAAO); Agencia Internacional para la Prevención de la Ceguera (IAPB). Programa Visión 2020; Consejo Internacional de Oftalmología (ICO), 2016. Disponible en: https://paao.org/wp-content/uploads/2016/05/guiaclinicaretinopatiadiabetica2016.pdf

World Health Organization (WHO). World Health Organization model list of essential medicines. 23rd list. Geneve: WHO, 2023. Disponible en: https://iris.who.int/bitstream/handle/10665/371090/WHO-MHP-HPS-EML-2023.02-eng.pdf

Sociedad Argentina de Retina y Vítreo (SARyV). Guía consensuada sobre diagnóstico y tratamiento de la degeneración macular asociada a la edad. Buenos Aires: SARyV, 2021. Disponible en: https://www.saryv.org.ar/images/Guia_consensuada_DMAE.pdf

Mallone F, Giustolisi R, Franzone F et al. Ten-year outcomes of intravitreal bevacizumab for myopic choroidal neovascularization: analysis of prognostic factors. Pharmaceuticals (Basel) 2021; 14: 1042.

Do DV, Nguyen QD, READ-2 Study Group et al. Ranibizumab for edema of the macula in diabetes study: 3-year outcomes and the need for prolonged frequent treatment. JAMA Ophthalmol 2013; 131: 139-145.

Bressler SB, Odia I, Glassman AR et al. Changes in diabetic retinopathy severity when treating diabetic macular edema with ranibizumab: DRCR.net protocol I 5-year report. Retina 2018; 38: 1896-1904.

Cai S, Bressler NM. Aflibercept, bevacizumab or ranibizumab for diabetic macular oedema: recent clinically relevant findings from DRCR.net protocol T. Curr Opin Ophthalmol 2017; 28: 636-643.

Rajendram R, Fraser-Bell S, Kaines A et al. A 2-year prospective randomized controlled trial of intravitreal bevacizumab or laser therapy (BOLT) in the management of diabetic macular edema: 24-month data: report 3. Arch Ophthalmol 2012; 130: 972-979.

Campochiaro PA, Heier JS, BRAVO Investigators et al. Ranibizumab for macular edema following branch retinal vein occlusion: six-month primary end point results of a phase III study. Ophthalmology 2010; 117: 1102.e1-1112.e1.

Heier JS, Campochiaro PA, Yau L et al. Ranibizumab for macular edema due to retinal vein occlusions: long-term follow-up in the HORIZON trial. Ophthalmology 2012; 119: 802-809.

Brown DM, Campochiaro PA, CRUISE Investigators et al. Ranibizumab for macular edema following central retinal vein occlusion: six-month primary end point results of a phase III study. Ophthalmology 2010; 117: 1124.e1-1133.e1.

Boyer D, Heier J, Brown DM et al. Vascular endothelial growth factor Trap-Eye for macular edema secondary to central retinal vein occlusion: six-month results of the phase 3 COPERNICUS study. Ophthalmology 2012; 119:1024-1032.

Holz FG, Roider J, Ogura Y et al. VEGF Trap-Eye for macular oedema secondary to central retinal vein occlusion: 6-month results of the phase III GALILEO study. Br J Ophthalmol 2013; 97: 278-284.

Yilmaz T, Cordero-Coma M. Use of bevacizumab for macular edema secondary to branch retinal vein occlusion: a systematic review. Graefes Arch Clin Exp Ophthalmol 2012; 250: 787-793.

Russo V, Barone A, Conte E et al. Bevacizumab compared with macular laser grid photocoagulation for cystoid macular edema in branch retinal vein occlusion. Retina 2009; 29: 511-515.

Hykin P, Prevost AT, LEAVO Study Group et al. Clinical effectiveness of intravitreal therapy with ranibizumab vs aflibercept vs bevacizumab for macular edema secondary to central retinal vein occlusion: a randomized clinical trial. JAMA Ophthalmol 2019; 137: 1256-1264.

Ehlers JP, Fekrat S. Retinal vein occlusion: beyond the acute event. Surv Ophthalmol 2011; 56: 281-299.

Epstein DL, Algvere PV, von Wendt G et al. Bevacizumab for macular edema in central retinal vein occlusion: a prospective, randomized, double-masked clinical study. Ophthalmology 2012; 119: 1184-1189.

Sadda SR (ed.). Ryan’s Retina. 7th ed. London: Elsevier, 2023.

Lee, YH, Kim YC. Central retinal thickness changes and risk of neovascular glaucoma after intravitreal bevacizumab injection in patients with central retinal vein occlusion. Sci Rep 2022: 12: 2051.

Ng, DSC, Ho M, Iu LPL, Lai, TYY. Safety review of anti-VEGF therapy in patients with myopic choroidal neovascularization. Expert Opin Drug Saf 2022; 21: 43.54.

Aljundi W, Gradinger F, Langenbucher A et al. Choroidal thickness as a possible predictor of non-response to intravitreal bevacizumab for macular edema after retinal vein occlusion. Sci Rep 2023; 13: 451.

Bro T, Derebecka M, Jørstad ØK, Grzybowski A. Off-label use of bevacizumab for wet age-related macular degeneration in Europe. Graefes Arch Clin Exp Ophthalmol 2020; 258: 503-511.

Rosenfeld PJ, Brown DM, MARINA Study Group et al. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med 2006; 355: 1419-1131.

Brown DM, Kaiser PK, Michels M, ANCHOR Study Group et al. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med 2006; 355: 1432-1444.

Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group, Martin DF, Maguire GM et al. Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results. Ophthalmology 2012; 119: 1388-1198.

IVAN Study Investigators, Chakravarthy U, Harding SP et al. Ranibizumab versus bevacizumab to treat neovascular age-related macular degeneration: one-year findings from the IVAN randomized trial. Ophthalmology 2012; 119: 1399-1411.

Chakravarthy U, Harding SP, IVAN Study Investigators et al. Alternative treatments to inhibit VEGF in age-related choroidal neovascularisation: 2-year findings of the IVAN randomised controlled trial. Lancet 2013; 382: 1258-1267.

Krebs I, Schmetterer L, MANTA Research Group et al. A randomised double-masked trial comparing the visual outcome after treatment with ranibizumab or bevacizumab in patients with neovascular age-related macular degeneration. Br J Ophthalmol 2013; 97: 266-271.

Berg K, Pedersen TR, Sandvik L, Bragadóttir R. Comparison of ranibizumab and bevacizumab for neovascular age-related macular degeneration according to LUCAS treat-and-extend protocol. Ophthalmology 2015; 122: 146-152.

Schauwvlieghe AM, Dijkman G, Hooymans JM et al. Comparing the effectiveness of bevacizumab to ranibizumab in patients with exudative age-related macular degeneration. The BRAMD Study. PLoS One 2016; 11: e0153052.

Kodjikian L, Souied EH, GEFAL Study Group et al. Ranibizumab versus bevacizumab for neovascular age-related macular degeneration: results from the GEFAL noninferiority randomized trial. Ophthalmology 2013; 120: 2300-2309.

American Society of Retina Specialists. Preferences and trends survey 2018. Chicago: ASRS, 2018.

Diabetic Retinopathy Clinical Research Network, Wells JA, Glassman AR et al. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. N Engl J Med 2015; 372: 1193-1203.

Diabetic Retinopathy Clinical Research Network, Elman MJ, Qin H et al. Intravitreal ranibizumab for diabetic macular edema with prompt versus deferred laser treatment: three-year randomized trial results. Ophthalmology 2012; 119: 2312-2318.

Ross EL, Hutton DW, Diabetic Retinopathy Research Network et al. Cost-effectiveness of aflibercept, bevacizumab, and ranibizumab for diabetic macular edema treatment: analysis from the Diabetic Retinopathy Clinical Research Network comparative effectiveness trial. JAMA Ophthalmol 2016; 134: 888-896.

Glasser DB, Parikh R, Lum F, Williams GA. Intravitreal anti-vascular endothelial growth factor cost savings achievable with increased bevacizumab reimbursement and use. Ophthalmology 2020; 127: 1688-1692.

Elshout M, Webers CAB, van der Reis MI, Schouten JSAG. A systematic review on the quality, validity, and usefulness of current cost-effectiveness studies for treatments of neovascular age-related macular degeneration. Acta Ophthalmol 2018; 96: 770-778.

Low A, Faridi A, Bhavsar KV et al. Comparative effective ness and harms of intravitreal antivascular endothelial growth factor agents for three retinal conditions: a systematic review and meta-analysis. Br J Ophthalmol 2019; 103: 442-451.

Hutton DW, Newman-Casey PA, Tavag M et al. Switching to less expensive blindness drug could save medicare Part B $18 billion over a ten-year period. Health Aff (Millwood) 2014; 33: 931-939.

Poku E, Rathbone J, Wong R et al. The safety of intravitreal bevacizumab monotherapy in adult ophthalmic conditions: systematic review. BMJ Open 2014; 4: e005244.

Published

2024-07-04

How to Cite

[1]
Martínez Peterlin, A., Pin Hidalgo, G., Sansinanea, M., Méndez, G.A., Berlatto, B., Paglieri, P., Settecase, F., Anzorena, D., Poffer, L., Crocco, F. and Valeiras, A. 2024. A retrospective study of the use of intravitreal bevacizumab in a public hospital in Argentina. Oftalmología Clínica y Experimental. 17, 2 (Jul. 2024), e204-e213. DOI:https://doi.org/10.70313/2718.7446.v17.n02.323.

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