New at Insight
NEW ARTICLESFor past Eyeware articles, visit our Eyecare News Archive |
Promising New Treatment for Macular DegenerationCreated:March 26, 2006The Bottom Line Avastin®, a drug that has been developed for colorectal cancer, is now surfacing as a potential treatment for those with wet macular degeneration who have failed other treatments. This study, based on the results of 81 eyes treated with it, shows that the treatment appears to be safe and of significant benefit.Methodology in Brief This study included the results of eighty-one eyes of 79 patients with wet macular degeneration who had failed treatment with either photodynamic therapy with Visudyne® or injection with Macugen® Potential subjects were not offered treatment if they had uncontrolled hypertension, recent heart attack or stroke. All patients had an injection of 1.25mg of the medicine into the jelly portion of the eye under a sterile fashion. Additional treatment was offered every month until the fluid in or under the retina resolved. Results No significant ocular or systemic side effects were observed. Fifty-five percent of patients had a reduction of >10% of baseline retinal thickness at 1 week after the injection. Of the 51 eyes with 8 weeks' follow-up, 25 had complete resolution of fluid or retinal detachment. At 4 and 8 weeks, mean VA improved from 20/200 to 20/125 (<0.0001). Over the past year there has been significant interest in new treatments for wet macular degeneration. While photodynamic therapy with Visudyne® or injection with Macugen® still represent the standard of care, we have recently seen some impressive results regarding Lucentis® (another injectable medicine). Lucentis®, to date, has not been approved for use in the US or Canada. Avastin® is a medicine that has been developed for the treatment of colorectal cancer. For this indication, the drug is given systemically through an intravenous. Some doctors have started injecting Avastin®, into the jelly of the eye, for the treatment of wet macular degeneration - given its potent anti-angiogenic properties. This was never the intention of the manufacturers (Genentech - who incidentally are the same company developing Lucentis®) and ,therefore, we do not have the usual safety and efficacy data supporting its use for wet macular degeneration. There is no clinical trial to support this practice - unlike photodynamic therapy with Visudyne®, injection with Macugen® and injection with Lucentis®. (Note: for drugs to be approved in the US and Canada and most developed nations, manufacturers have to present the results of carefully planned and meticulously conducted randomized clinical trials demonstrating the safety and efficacy of a compound to national regulatory bodies. After careful scrutiny of these results, these agencies decide whether these medicines should be offered to patients with a given disease. However, even regulatory approval doesn't necessarily mean that there will be no untoward side effects of medicines; there is always a risk of a complication. Additionally, if a number of adverse effects occur, the medicine approval of a medicine can be revoked (or a manufacturer can voluntarily remove it). Why would one consider using or having an Avastin® injection? Although it is very expensive as a systemic treatment, it is quite inexpensive for wet macular degeneration - given the small doses that need to be injected into the eye for this condition. So if the safety and efficacy of Avastin® can be demonstrated, it has the potential to positively impact those with wet macular degeneration and offer a significant cost advantage from the perspective of health care insurers. This particular study, while not perfect, shows that the drug appears to be safe in this sample (81 eyes) and also appears to improve vision and cause resolution of fluid. These initial results seem quite promising; a medicine that may be able to improve vision for those with wet macular degeneration and cost the healthcare system very little. Let’s hope that continued study of this promising treatment continues to demonstrate its safety and efficacy. If you wish to read the full article, please see the following, published in Ophthalmology: Avery RL, Pieramici DJ, Rabena MD, Castellarin AA, Nasir Maan, Giust MJ. Intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration. Ophthalmology. 2006 Mar;113(3):363-372.e5. Epub 2006 Feb 3. Note: Medically reviewed March 2006 © 2006 MacDegen.com All rights reserved. |