Safety and Efficacy of Intravitreal Bevacizumab Followed by Pegaptanib Maintenance as a Treatment Regimen for Age-Related Macular Degeneration

BACKGROUND AND OBJECTIVE Vascular endothelial growth factor (VEGF)-A, both necessary and sufficient in promoting ocular neovascularization, is an attractive therapeutic target. Combining nonselective and selective VEGF blockade may provide clinical benefit with minimal risks in the treatment of neovascular age-related macular degeneration (AMD). PATIENTS AND METHODS Twenty patients with all subtypes of neovascular AMD and a broad range of baseline vision were treated with intravitreal bevacizumab followed by pegaptanib sodium for 54 weeks. Visual acuity measurements, biomicroscopy, funduscopy, fluorescein angiography, optical coherence tomography, and adverse event assessments were performed. RESULTS Mean visual acuity improved from approximately 20/200 at baseline to 20/80. All patients experienced an improvement in retinal thickness, ranging from -47 to -297 microns. Adverse events were limited to transient irritation or redness. No significant elevation in intraocular pressure occurred following either bevacizumab or pegaptanib injections. CONCLUSIONS Nonselective VEGF blockade with bevacizumab induction and selective VEGF₁₆₅ blockade with pegaptanib as maintenance therapies may offer clinically meaningful outcomes with acceptable safety profiles in patients with AMD. [<CITE>Ophthalmic Surg Lasers Imaging</CITE> 2006;37:446-454.] AUTHORS From the Schepens Eye Research Institute and the Department of Ophthalmology, Harvard Medical School; and Ophthalmic Consultants of Boston, Boston, Massachusetts. Accepted for publication October 8, 2006. Presented in part at the Association for Research in Vision and Ophthalmology annual meeting, Fort Lauderdale, Florida, May 4, 2006. Drs. Hughes and Sang receive research funds from (OSI) Eyetech. Address reprint requests to Mark S. Hughes, MD, Ophthalmic Consultants of Boston, 50 Staniford Street, Suite 600, Boston, MA 02114.