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When Less is More: Comparing Retreatment Rates of Anti-VEGF Therapies for Retinopathy of Prematurity

Title of Article: Comparison in Retreatments between Bevacizumab and Ranibizumab Intravitreal Injections for Retinopathy of Prematurity: A Multicenter Study.

What are the key takeaway points from this article?

Retinopathy of prematurity (ROP) is a proliferative vascular disorder of the retina affecting premature infants and is the number one cause of preventable blindness in the US. Laser photocoagulation as well as anti-vascular endothelial growth factor (anti-VEGF) intravitreal injections are common treatment modalities. As bevacizumab and ranibizumab anti-VEGF injections are increasingly being used in practice, the authors of this study sought to compare their relative retreatment rates and determine whether dosage played a role in subsequent retreatment.

In this multicenter, retrospective consecutive series, the authors collected data from 16 sites across the US including type and dose of anti-VEGF injections, retreatment rates and time to retreatment. The primary analysis examined 567 eyes of 307 patients, and included premature infants whose ROP was initially managed with anti-VEGF therapy, while those patients initially treated with laser prior to anti-VEGF therapy were excluded.

Compared to the no-retreatment group, the retreatment group had more aggressive ROP (34% vs. 18%, P <0.001) and a greater percentage of zone 1 ROP, affecting the most central zone covering the optic nerve, at 49% vs. 34%, (P < 0.001). Ranibizumab use demonstrated higher rates of retreatment when compared to bevacizumab (58% vs. 37%, P, 0.001). Lower doses of bevacizumab were associated with a higher rate of retreatment when compared to higher dose therapy (R2 = 0.84, P =0.01). Moreover, the authors observed a dose-specific trend with bevacizumab whereby higher doses resulted in lower retreatment rates.

These results provide a valuable comparison of retreatment rates in two commonly used anti-VEGF therapies for ROP. Importantly, while this contribution can provide additional guidance to physicians when selecting management, there remains debate in the literature with respect to which Anti-VEGF drug is preferable in the long-term. The authors of this study cautioned that while these results are favorable to higher doses of bevacizumab, the long-term effects of anti-VEGF therapy on organ development is unknown and invites further examination.

Publication Date: April, 2023


Patel, N. A., Acaba-Berrocal, L. A., Hoyek, S., Fan, K. C., Martinez-Castellanos, M. A., Baumal, C. R., Harper, C. A., 3rd, Berrocal, A. M., & Retinopathy of Prematurity Injection Consortium (ROPIC) (2023). Comparison in Retreatments between Bevacizumab and Ranibizumab Intravitreal Injections for Retinopathy of Prematurity: A Multicenter Study. Ophthalmology, 130(4), 373–378.

Summary By: Natalie Mezey


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