Bevacizumab, Ranibizumab May Be Equivalent in Treating Macular Edema

Results from a recent retrospective study on patients with macular edema (ME) due to branch retinal vein occlusion (BRVO) have indicated that bevacizumab can be considered a clinically effective alternative treatment to ranibizumab for an initial 3 loading doses.1

Retinal vein occlusion (RVO) is the second most common retinal vascular disorder worldwide, after diabetic retinopathy. It is considered one of the most important causes of visual loss. RVO is associated with several risk factors, including diabetes mellitus, thrombophilia and hypercoagulation, hyperlipidemia, hypertension, systemic and inflammatory diseases, and a variety of medications.2

“There are limited studies in the literature comparing the loading doses of bevacizumab and ranibizumab,” wrote Sibel Akdemir, MD, department of ophthalmology, University of Health Sciences, Trabzon Kanuni Training and Research Hospital, and colleagues. “Is there any difference between the loading doses of bevacizumab and approved anti-VEGF agents in terms of efficacy in the treatment of ME due to BRVO?”1

Anti-vascular endothelial growth factor (anti-VEGF) treatment is considered the gold standard when dealing with ME secondary to BRVO. Bevacizumab is a humanized, recombinant, monoclonal antibody anti-VEGF agent initially developed for cancer; despite being off-label, bevacizumab is widely used to treat ocular conditions due to its low cost. Ranibizumab, another monoclonal antibody, neutralizes all isoforms of VEGF-A and is approved for intraocular use.1

Prior studies have indicated that both are safe for the treatment of ME secondary to BRVO. Given the current literature’s emphasis on the 3 loading doses and pro re nata (PRN) regimen over other anti-VEGF regimens, investigators structured this study to compare the effectiveness of both medications.1

Akdemir and colleagues included 49 eyes of 49 patients with BRVO in the study, all of whom were followed up at a tertiary center between 2017 and 2020. Ophthalmologic examination files were reviewed; investigators recorded best corrected visual acuity (BCVA), biomicroscopy, funduscopy, intraocular pressure, optical coherence tomography (OCT), and fluorescein angiography (FA).1

Patients who had not received prior treatment, who had BRVO with a duration <1 month, and with central macular thickness (CMT) ≥250 µm at the first visit were included. Patients with other retinal diseases, a follow-up period <1 year, or a history of major cardiovascular or cerebrovascular disease within the last 6 months were excluded from the final tally.1

The team divided patients into 2 groups: those treated with bevacizumab first and those treated with ranibizumab first. The former received 3 loading doses of bevacizumab followed by a PRN regimen of 0.5 mg ranibizumab. The latter was given three loading doses of ranibizumab followed by a PRN regimen of ranibizumab. The medications were injected into the vitreous space through the pars plana.1

After follow-up, the bevacizumab group exhibited a change in mean BCVA from logMAR 0.79 (standard deviation [SD], 0.2) to logMAR 0.33 (SD, 0.3) after three injections (P <.001), while the ranibizumab group changed from logMAR 0.65 (SD, 0.3) at baseline to logMAR 0.23 (SD, 0.2) after three injections (P <.001). No significant difference in BCVA gain between the groups was noted (P = .51).1

In the bevacizumab group, mean CMT decreased from 556.4 (SD, 143.5) µm at baseline to 285.2 (SD, 96.5) µm after 3 bevacizumab injections (P <.001), while the ranibizumab group’s mean CMT decreased from 520.6 (SD, 172.5) µm at baseline to 269.6 (SD, 72.5) µm after 3 ranibizumab injections (P <.001). No significant difference was noted in CMT decrease between the groups.1

Akdemir and colleagues noted no statistically significant difference between the treatment groups in CMT reduction, BCVA gain, ocular and systemic adverse events, or number of injections. The retreatment rate was lower in ranibizumab after the initial 3 injections.1

“Therefore, bevacizumab may be considered a clinically effective alternative to ranibizumab for the initial three loading doses in patients with BRVO-related ME, particularly when cost is a limiting factor,” Akdemir and colleagues wrote. “Larger sample sizes from randomized clinical trials are needed for further assessment.”1

References

1. Akdemir SC, Taşlı NG. Comparison of three loading doses of bevacizumab and ranibizumab for macular edema due to branch retinal vein occlusion. BMC Ophthalmol. 2025;25(1):304. Published 2025 May 22. doi:10.1186/s12886-025-04126-4

2. Jaulim A, Ahmed B, Khanam T, Chatziralli IP. Branch retinal vein occlusion: epidemiology, pathogenesis, risk factors, clinical features, diagnosis, and complications. An update of the literature. Retina. 2013;33(5):901-910. doi:10.1097/IAE.0b013e3182870c15