Bevacizumab Linked to Greater ROP Retreatment than Ranibizumab

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A real-world comparison of the anti-VEGF agents suggests certain doses are associated with more likelihood of retreatment.

Leading anti-VEGF therapy options for retinopathy of prematurity (ROP) may be associated with different risk of retreatment based on the drug, according to new findings.

In data presented at the American Academy of Ophthalmology (AAO) 2022 Annual Meeting in Chicago this week, a team of US investigators observed differences in rate of patient retreatment between ranibizumab and bevacizumab when prescribed to treat ROP. The findings provide new context into the refined prescription strategies for the leading retina disease drug class.

Led by Luis Acaba-Berrocal, MD, of the Illinois Eye and Ear Infirmary, investigators sought to compare the types and dosages of anti-VEGF therapies for patients with ROP in a real-world setting.

“Despite the broad use of anti-VEGF for ROP, little is known regarding real-world retreatment rates in relation to dose and type of anti-VEGF,” they wrote.

Their analysis included a multicenter, retrospective, consecutive series assessment of patients with ROP treated with intravitreal anti-VEGF injections at 16 US clinics from 2007-2021. The team collected patient demographics, the type and dosage of anti-VEGF therapy, and findings from real-world exams at the time. Primary endpoint outcome was the rate of retreatments.

Investigators observed 337 patient eyes without retreatments and 230 patient eyes with retreatments. Approximately two-thirds of each subpopulations were male; a majority of patients in each were at stage 3 of ROP at the time of their anti-VEGF injection.

Among patients receiving bevacizumab, 63% did not require retreatment (P <.001). A majority of patients received either 0.625 mg (n = 214) or 0.5 mg (n = 25) doses of bevacizumab in the single-treatment arm.

Among patients receiving ranibizumab, 58% required retreatment (P <.001). The most popular doses among ranibizumab patients receiving retreatment were 0.25 and 0.2 mg.

Acaba-Berrocal and colleagues observed a 61% retreatment rate among patients receiving ≤0.5 mg bevacizumab, versus a 30% rate among patients receiving a ≥0.625 mg dose (P <.001). They additionally noted a 68% retreatment rate among patients receiving a ≥0.2 mg ranibizumab dose, versus 52% of those receiving a 0.15 mg dose (P = .11).

The team concluded that ranibizumab was associated with greater rates of retreatment versus bevacizumab among patients with ROP.

“Lower doses of bevacizumab were associated with higher rates of retreatment compared to standard dosages,” they wrote. “There was a dose specific trend with higher doses trending towards lower retreatments for bevacizumab.”

The study, “Retreatments and Outcomes After Intravitreal Anti-VEGF Injections for ROP: A Multicenter Study,” was presented at AAO 2022.