Anti-VEGF Drug May Improve Choroidal Neovascularization in Multifocal Choroiditis

Intravitreal bevacizumab appears to be more effective than photodynamic therapy at restoring functional vision in patients with subfoveal choroidal neovascularization secondary to multifocal choroiditis, according to new research in the September issue of Archives of Ophthalmology.

Previous studies have reported successful treatment of subfoveal choroidal neovascularization (CNV) secondary to different disorders with bevacizumab, an anti–vascular endothelial growth factor (VEGF) agent. Other studies have shown that photodynamic therapy (PDT) can help stabilize but not improve vision.

“The most frequent cause of severe visual acuity deterioration in patients affected by multifocal choroiditis is CNV, occurring in as many as one-third of patients, but currently there is no general consensus, to our knowledge, about the most appropriate treatment,” say researchers led by Dr. Maurizio Battaglia Parodi of the Scientific Institute of the University Vita-Salute San Raffaele in Milan, Italy.

For that reason, Dr. Parodi and colleagues conducted a prospective pilot randomized clinical trial among patients treated with PDT or intravitreal bevacizumab injection during a 1-year follow-up period between March 15, 2005, and April 30, 2009 (Arch. Ophthalmol. 2010;128:1100-3). They enrolled 27 patients (27 eyes) with subfoveal CNV secondary to multifocal choroiditis and randomized 13 patients to received PDT and 14 to receive bevacizumab. Subjects consisted of 18 women and 9 men aged 22-57 (mean age, 39 years). Patients in the bevacizumab group underwent a mean 1.7 out of 4 possible treatments, while those in the PDT group underwent a mean 3.8 treatments.

At 12 months, 5 of 14 eyes (36%) in the bevacizumab-treated group gained more than three lines of best-corrected visual acuity vs. none of the PDT-treated eyes. Twelve eyes (86%) in the bevacizumab group and 6 eyes (46%) in the PDT group gained more than one line of BCVA, the researchers found. Mean BCVA (logMAR) went from 0.45(0.2) to 0.47(0.2) in the PDT group and from 0.48(0.2) to 0.30 (0.2) in the bevacizumab subgroups. Meanwhile, central macular thickness progressively declined from 299 mcm at baseline to 256 mcm at 12 months in the PDT group and from 289 mcm to 234 mcm in the bevacizumab group, a statistically significant reduction.

There were no reports of complications, signs of multifocal choroiditis activity or new lesions during follow-up, the researchers said.

Although other studies suggest that PDT may help stabilize visual acuity and lead to limited functional improvement, results of this study suggest that bevacizumab “is superior to PDT in improving the mean BCVA during a 12-month follow-up,” the researchers say.

Limitations of this study include a small sample size, limited follow-up of 1 year, and no control group to mask with sham treatment. “Nevertheless,” the researchers wrote, multifocal choroiditis “is a rather uncommon entity, which makes the planning of a randomized clinical trial difficult” the researchers say.

Bevacizumab is approved in the United States only for the treatment of several metastatic cancers and has been used off label to treat age-related macular degeneration.

Further studies with longer follow-up are necessary, the researchers say.

The authors reported no financial conflicts of interest.

Intravitreal bevacizumab appears to be more effective than photodynamic therapy at restoring functional vision in patients with subfoveal choroidal neovascularization secondary to multifocal choroiditis, according to new research in the September issue of Archives of Ophthalmology.

Previous studies have reported successful treatment of subfoveal choroidal neovascularization (CNV) secondary to different disorders with bevacizumab, an anti–vascular endothelial growth factor (VEGF) agent. Other studies have shown that photodynamic therapy (PDT) can help stabilize but not improve vision.

“The most frequent cause of severe visual acuity deterioration in patients affected by multifocal choroiditis is CNV, occurring in as many as one-third of patients, but currently there is no general consensus, to our knowledge, about the most appropriate treatment,” say researchers led by Dr. Maurizio Battaglia Parodi of the Scientific Institute of the University Vita-Salute San Raffaele in Milan, Italy.

For that reason, Dr. Parodi and colleagues conducted a prospective pilot randomized clinical trial among patients treated with PDT or intravitreal bevacizumab injection during a 1-year follow-up period between March 15, 2005, and April 30, 2009 (Arch. Ophthalmol. 2010;128:1100-3). They enrolled 27 patients (27 eyes) with subfoveal CNV secondary to multifocal choroiditis and randomized 13 patients to received PDT and 14 to receive bevacizumab. Subjects consisted of 18 women and 9 men aged 22-57 (mean age, 39 years). Patients in the bevacizumab group underwent a mean 1.7 out of 4 possible treatments, while those in the PDT group underwent a mean 3.8 treatments.

At 12 months, 5 of 14 eyes (36%) in the bevacizumab-treated group gained more than three lines of best-corrected visual acuity vs. none of the PDT-treated eyes. Twelve eyes (86%) in the bevacizumab group and 6 eyes (46%) in the PDT group gained more than one line of BCVA, the researchers found. Mean BCVA (logMAR) went from 0.45(0.2) to 0.47(0.2) in the PDT group and from 0.48(0.2) to 0.30 (0.2) in the bevacizumab subgroups. Meanwhile, central macular thickness progressively declined from 299 mcm at baseline to 256 mcm at 12 months in the PDT group and from 289 mcm to 234 mcm in the bevacizumab group, a statistically significant reduction.

There were no reports of complications, signs of multifocal choroiditis activity or new lesions during follow-up, the researchers said.

Although other studies suggest that PDT may help stabilize visual acuity and lead to limited functional improvement, results of this study suggest that bevacizumab “is superior to PDT in improving the mean BCVA during a 12-month follow-up,” the researchers say.

Limitations of this study include a small sample size, limited follow-up of 1 year, and no control group to mask with sham treatment. “Nevertheless,” the researchers wrote, multifocal choroiditis “is a rather uncommon entity, which makes the planning of a randomized clinical trial difficult” the researchers say.

Bevacizumab is approved in the United States only for the treatment of several metastatic cancers and has been used off label to treat age-related macular degeneration.

Further studies with longer follow-up are necessary, the researchers say.

The authors reported no financial conflicts of interest.

Intravitreal bevacizumab appears to be more effective than photodynamic therapy at restoring functional vision in patients with subfoveal choroidal neovascularization secondary to multifocal choroiditis, according to new research in the September issue of Archives of Ophthalmology.

Previous studies have reported successful treatment of subfoveal choroidal neovascularization (CNV) secondary to different disorders with bevacizumab, an anti–vascular endothelial growth factor (VEGF) agent. Other studies have shown that photodynamic therapy (PDT) can help stabilize but not improve vision.

“The most frequent cause of severe visual acuity deterioration in patients affected by multifocal choroiditis is CNV, occurring in as many as one-third of patients, but currently there is no general consensus, to our knowledge, about the most appropriate treatment,” say researchers led by Dr. Maurizio Battaglia Parodi of the Scientific Institute of the University Vita-Salute San Raffaele in Milan, Italy.

For that reason, Dr. Parodi and colleagues conducted a prospective pilot randomized clinical trial among patients treated with PDT or intravitreal bevacizumab injection during a 1-year follow-up period between March 15, 2005, and April 30, 2009 (Arch. Ophthalmol. 2010;128:1100-3). They enrolled 27 patients (27 eyes) with subfoveal CNV secondary to multifocal choroiditis and randomized 13 patients to received PDT and 14 to receive bevacizumab. Subjects consisted of 18 women and 9 men aged 22-57 (mean age, 39 years). Patients in the bevacizumab group underwent a mean 1.7 out of 4 possible treatments, while those in the PDT group underwent a mean 3.8 treatments.

At 12 months, 5 of 14 eyes (36%) in the bevacizumab-treated group gained more than three lines of best-corrected visual acuity vs. none of the PDT-treated eyes. Twelve eyes (86%) in the bevacizumab group and 6 eyes (46%) in the PDT group gained more than one line of BCVA, the researchers found. Mean BCVA (logMAR) went from 0.45(0.2) to 0.47(0.2) in the PDT group and from 0.48(0.2) to 0.30 (0.2) in the bevacizumab subgroups. Meanwhile, central macular thickness progressively declined from 299 mcm at baseline to 256 mcm at 12 months in the PDT group and from 289 mcm to 234 mcm in the bevacizumab group, a statistically significant reduction.

There were no reports of complications, signs of multifocal choroiditis activity or new lesions during follow-up, the researchers said.

Although other studies suggest that PDT may help stabilize visual acuity and lead to limited functional improvement, results of this study suggest that bevacizumab “is superior to PDT in improving the mean BCVA during a 12-month follow-up,” the researchers say.

Limitations of this study include a small sample size, limited follow-up of 1 year, and no control group to mask with sham treatment. “Nevertheless,” the researchers wrote, multifocal choroiditis “is a rather uncommon entity, which makes the planning of a randomized clinical trial difficult” the researchers say.

Bevacizumab is approved in the United States only for the treatment of several metastatic cancers and has been used off label to treat age-related macular degeneration.

Further studies with longer follow-up are necessary, the researchers say.

The authors reported no financial conflicts of interest.