SHORT-TERM EFFICACY OF INTRAVITREAL BEVACIZUMAB IN TREATMENT NAIVE PATIENTS- REAL WORLD EVIDENCE IN PAKISTAN

Authors

  • Hajra Arshad Malik Medical Retina Clinic, Amanat Eye Hospital, Rawalpindi-Pakistan
  • Rayyan Sabih Medical Retina Clinic, Amanat Eye Hospital, Rawalpindi-Pakistan
  • Maham Khalid Medical Retina Clinic, Amanat Eye Hospital, Rawalpindi-Pakistan
  • Hina Khan Medical Retina Clinic, Amanat Eye Hospital, Rawalpindi-Pakistan
  • Maha Asrar Medical Retina Clinic, Amanat Eye Hospital, Rawalpindi-Pakistan
  • Aamir Asrar Medical Retina Clinic, Amanat Eye Hospital, Rawalpindi-Pakistan
  • Muhammad Asif Department of Public Health, Government College University, Faisalabad

Abstract

Background: Anti-VEGF agents have been proven to be effective in treating macular oedema secondary to a multitude of pathological conditions. However, in large clinical trial settings, the results may be overstated. This study aimed to evaluate the short-term efficacy of intraocular Bevacizumab in consecutive patients with macular oedema being treated in a ‘real-world’ setting in Pakistan. Methods: A prospective study was conducted at Amanat Eye Hospital, Rawalpindi from August 2018 to November 2019. Thirty-five eyes of 29 patients with macular oedema were treated with monthly intravitreal Bevacizumab injections for three consecutive months. Best-corrected visual acuity (BCVA), and OCT parameters including central retinal thickness (CRT) and macular volume were assessed prior to the injections and then 4 weeks post the final injection and compared. Results: BCVA improved from 1.00±0.44 at baseline to 0.83±0.48 four weeks after the third intravitreal injection. CRT decreased significantly from 492.77±192.31 at baseline to 362.91±126.11 (p<0.05), and macular volume decreased significantly from 11.61±2.39 at baseline to 9.87±1.68 (p<0.05) four weeks after the third intravitreal injection. No systemic or ocular complications were observed during the course of the study. Conclusion: Treatment with intravitreal Bevacizumab injections was found safe and resulted in clinically and statistically significant improvement in SD-OCT parameters and visual acuity in patients with macular oedema secondary to various retinal pathologies. However, the improvement in a real-world setting was sub-optimal in comparison to larger clinical trials for specific diseases in the developed world

Author Biographies

Hajra Arshad Malik, Medical Retina Clinic, Amanat Eye Hospital, Rawalpindi-Pakistan

Research Assistant,

Rayyan Sabih, Medical Retina Clinic, Amanat Eye Hospital, Rawalpindi-Pakistan

Research Assistant

Maham Khalid, Medical Retina Clinic, Amanat Eye Hospital, Rawalpindi-Pakistan

Research Assistant

Hina Khan, Medical Retina Clinic, Amanat Eye Hospital, Rawalpindi-Pakistan

Consultant Ophthalmologist, Head of Ophthalmic Diagnostics MBBS, FCPS, FRCS; Fellowship in Medical Retina and Uveitis (UK)  

Maha Asrar, Medical Retina Clinic, Amanat Eye Hospital, Rawalpindi-Pakistan

Research Assistant

Aamir Asrar, Medical Retina Clinic, Amanat Eye Hospital, Rawalpindi-Pakistan

Chief Consultant Ophthalmologist MBBS, MRCOphth, FRCS Fellowship in Vitreo-retinal surgery Fellowship in Corneo-refractive surgery

Muhammad Asif, Department of Public Health, Government College University, Faisalabad

Lecturer at Department of Public Health, GCUF.

References

Sacconi R, Giuffre C, Corbelli E, Borrelli E, Querques G, Bandello F. Emerging therapies in the management of macular edema: a review. F1000Res 2019;8:F1000 Faculty Rev-1413.

Wykoff CC, Clark WL, Nielsen JS, Brill J V, Greene LS, Heggen CL. Optimizing Anti-VEGF Treatment Outcomes for Patients with Neovascular Age-Related Macular Degeneration. J Manag Care Spec Pharm 2018;24(2-a Suppl):S3–15.

Mansour AM, Al-Ghadban SI, Yunis MH, El-Sabban ME. Ziv-aflibercept in macular disease. Br J Ophthalmol 2015;99(8):1055–9.

Malik D, Tarek M, Caceres del Carpio J, Ramirez C, Boyer D, Kenney MC, et al. Safety profiles of anti-VEGF drugs: bevacizumab, ranibizumab, aflibercept and ziv-aflibercept on human retinal pigment epithelium cells in culture. Br J Ophthalmol 2014;98(Suppl 1):i11–6.

Akiyode O, Dunkelly-Allen N. Ranibizumab: A Review of Its Use in the Treatment of Diabetic Retinopathy in Patients with Diabetic Macular Edema. J Pharm Technol 2016;32(1):22–8.

Jan S, Nazim M, Karim S, Hussain Z. Intravitreal Bevacizumab: Indications and Complications. J Ayub Med Coll Abbottabad 2016;28(2):364–8.

Tareen IUH, Rahman A, Mahar PS, Memon MS. Primary effects of intravitreal bevacizumab in patients with diabetic macular edema. Pak J Med Sci 2013;29(4):1018–22.

Naeem S, Rafe A. Visual outcome after intravitreal bevacizumab (Avastin) in the treatment of branch retinal vein occlusion. Pak Armed Forces Med J 2019;69(2):391–6.

Lekha T, Prasad HN, Sarwate RN, Patel M, Karthikeyan S. Intravitreal Bevacizumab for Choroidal Neovascularization Associated with Angioid Streaks: Long-term Results. Middle East Afr J Ophthalm ol 2017;24(3):136–42.

Wells JA, Glassman AR, Ayala AR, Jampol LM, Aiello LP, Antoszyk AN, et al. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. N Engl J Med 2015;372(13):1193–203.

Kornhauser T, Schwartz R, Goldstein M, Neudorfer M, Loewenstein A, Barak A. Bevacizumab treatment of macular edema in CRVO and BRVO: long-term follow-up. (BERVOLT study: Bevacizumab for RVO long-term follow-up). Graefes Arch Clin Exp Ophthalmol 2016;254(5):835–44.

Campochiaro PA, Heier JS, Feiner L, Gray S, Saroj N, Rundle AC, 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(6):1102–12.

Brown DM, Campochiaro PA, Singh RP, Li Z, Gray S, Saroj N, 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(6):1124–33.

Published

2021-04-23

Issue

Vol. 33 No. 2 (2021): Journal of Ayub Medical College Abbottabad

Section

ORIGINAL ARTICLE

License

Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License  CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.

USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.

AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.