Intravitreal bevacizumab versus combined intravitreal bevacizumab and triamcinolone for neovascular age-related macular degeneration: six-month results of a randomized clinical trial.

Abstract

PURPOSE:

To determine whether combined intravitreal bevacizumab (IVB) and triamcinolone (IVT) is more effective than IVB alone in neovascular age-related macular degeneration.

METHODS:

This was a prospective, randomized clinical trial performed at two centers. Eligible eyes were assigned randomly to one of the two study arms. In the IVB group, 3 consecutive injections of 1.25 mg of bevacizumab were given 6 weeks apart, while in the IVB/IVT group, the first of the triple IVB injections was combined with 2 mg of IVB. A fourth IVB was injected in eyes demonstrating active choroidal neovascularization at Week 24.

RESULTS:

Sixty and 55 eyes were in the IVB and IVB/IVT groups, respectively. Best-corrected visual acuity improved, and central macular thickness was reduced significantly in both groups at all time points. Visual improvement was more pronounced in the IVB/IVT group compared with the IVB group 6 weeks (8.5 ± 14.4 vs. 3.8 ± 8.9 letters, P = 0.04) and 12 weeks (11.8 ± 16.6 vs. 6.2 ± 10.8 letters, P = 0.03) after initiation of therapy. However, there was no significant difference in visual improvement at Week 24 (11.3 ± 17.2 letters in the IVB/IVT group vs. 8.7 ± 15.6 letters in the IVB group, P = 0.40). The IVB/IVT group showed significantly less need for a fourth injection at Week 24 (34.5% vs. 53.3% in the IVB/IVT and IVB groups, respectively, P = 0.04).

CONCLUSION:

Mandated therapy with IVB improved best-corrected visual acuity and decreased central macular thickness in neovascular age-related macular degeneration. The addition of low-dose IVT temporarily increased the therapeutic efficacy in the early postinjection period and resulted in fewer requirements for repeat IVB injections at 6 months; however, final levels of visual improvement were comparable in the 2 study groups.

• Authors: Hamid Ahmadieh, Ramin Taei, Mohammad Riazi-Esfahani, Niloufar Piri, Mansour Homayouni, Narsis Daftarian, Mehdi Yaseri
• Journal: Retina (Philadelphia, Pa.) (Retina) Vol. 31 Issue 9 Pg. 1819-26 (Oct 2011) ISSN: 1539-2864 [Electronic] United States
• PMID: 21555967 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Angiogenesis Inhibitors
• Antibodies, Monoclonal, Humanized
• Glucocorticoids
• VEGFA protein, human
• Vascular Endothelial Growth Factor A
• Bevacizumab
• Triamcinolone Acetonide

Topics

• Aged
• Aged, 80 and over
• Angiogenesis Inhibitors (therapeutic use)
• Antibodies, Monoclonal, Humanized (therapeutic use)
• Bevacizumab
• Drug Therapy, Combination
• Female
• Fluorescein Angiography
• Follow-Up Studies
• Glucocorticoids (therapeutic use)
• Humans
• Intravitreal Injections
• Male
• Middle Aged
• Prospective Studies
• Retreatment
• Tomography, Optical Coherence
• Treatment Outcome
• Triamcinolone Acetonide (therapeutic use)
• Vascular Endothelial Growth Factor A (antagonists & inhibitors)
• Visual Acuity (physiology)
• Wet Macular Degeneration (diagnosis, drug therapy, physiopathology)