From Paris- The 24th Annual Meeting of the American Association of Retinal Specialists

From Paris- The 24th Annual Meeting of the American Association of Retinal Specialists and the 6th Annual Meeting of The European Vitreoretinal Society, Cannes, France

The two-year results from the MARINA study were reported again and, in a word, très bien. Two years after study entry, 95% of patients, who were injected monthly with 0.5mg of Lucentis®, (ranibizumab), met the efficacy endpoint, which meant they didn’t lose 15 or more letters of vision. On average the entire group gained 6.6 letters or just over one line of vision. A third of the treated patients gained 15 or more , (three lines), of vision and 40% were 20/40 or better. The one-year results from the ANCHOR study were similar. These results are now the high standards against which new treatments will be measured.

Retinal experts all over the world have had a lot of experience using Avastin®, (bevacizumab), to treat neovascular AMD before Lucentis® was approved. Experts in Europe are still using Avastin® since Lucentis® has not yet been approved. There were a number of studies reported at this meeting which concluded that Avastin® was very close to or as good as Lucentis®. Most retinal experts in the hallway opined that Avastin® was as good. The studies that were reported however, were nonrandomized and had limited follow-up. It’s easy to get mesmerized by the initial, “WOW,” effect when the patient returns with no fluid and improved vision after an injection of either drug. I must admit that I haven’t seen much difference between the two drugs but, like everyone else at the meeting, believe a randomized, controlled study testing the two drugs, head to head, is needed. Such a trial is in the works.

Lucentis® and Avastin® cause resolution of most of the fluid within and under the retina within days after injection in almost every patient. Patients may still have some fluid one month after injection but it’s usually much less than pre-injection. This remaining bit of fluid almost always resolves with additional injections. Either drug is an excellent treatment. It’s hard to imagine another drug that would be better at getting rid of fluid and stopping the growth of the neovascular membrane. A drug would have to have the same visual results and also do one of the following to be better than Lucentis®:

1. Be administered less often.
2. Be cheaper,
3. Cause involution of the CNV so that therapy could be stopped.
4. Cause better visual acuity results by limiting scarring beneath the retina.
5. Prevent the CNV from developing in the first place, (the best treatment)

Retinal experts are working feverishly on 1-3 above. Pharmaceutical companies are working on nos. 3-5. In the next blog, I’ll discuss “as needed” therapy for Lucentis® or Avastin® and combination treatments.