Low Dose Bevacizumab, Ranibizumab Linked With Regression in Retinopathy of Prematurity

LONG BEACH, CA – APRIL 01: LONG BEACH, CALIF. USA –Tony Urbiha gets an injection from Dr. Stanley Carson in his Long Beach, Calif. office on June 8, 2011. Urbiha suffers from macular degeneration. Just a few years ago, people of all ages who had the degenerative eye disease were told that they would eventually go blind. Then came a breakthrough, a treatment that seems to halt and sometimes even slightly reverse the condition in one kind of macular degeneration. The treatments include frequent shots in the eyeball to prevents the progression of the disease. Patients come at regular intervals, and special cameras show the condition of the retina and whether a shot is required at that visit. (Photo by Jeff Gritchen/Digital First Media/Orange County Register via Getty Images)
The anti-VEGF drugs effectively induce disease regression, the report shows.

Low dose intravitreal bevacizumab (0.25 mg and 0.125 mg) and ranibizumab (0.15mg) is effective in inducing regression among patients with retinopathy of prematurity (ROP), according to research published in Ophthalmology Retina. 

The study included 39 eyes of 20 infants. Participants were separated into 3 different injection protocols: group 1 consisted of 16 eyes treated with 0.25 mg intravitreal bevacizumab (IVB), group 2 consisted of 16 eyes treated with 0.125 mg IVB, and group 3 consisted of 7 eyes treated with 0.15 mg intravitreal ranibizumab.

The average gestational age was 25+1 (mean+SE) weeks with a birth weight of 603+26 grams, the researchers noted. They found no significant differences between gestational age, birth weight or gender between the treatment groups. All participants experienced initial complete regression, and all maintained it at 4 weeks. 

After 4 weeks, 17 eyes (44%) required retreatment. In group 1, retreatment occurred in 6/16 (38%) of eyes; 8.3±0.8 (range: 6.1-10.7) weeks after injection. In group 2, retreatment occurred in 10/16 (63%) of eyes; 8.4±0.4 (range: 7.1-10) weeks after injection. In group 3, retreatment occurred in 1/7 (14%) eyes 9.0 weeks after injection. 

ROP was associated with a significantly increased risk of late reactivation (HR 5.78 (95% CI 1.76-19.0), P =.004). Retreatment was associated with a lower birth weight (HR 0.995 [95% CI 0.991-0.999] per gram, P =.035).  

On the last follow up visit at 60 weeks postmenstrual age, all eyes had favorable retinal structure. No deaths or adverse events were reported.

Study limitations include the relatively small sample size and single center design. 

Reference

Zhang C, Reynolds AL, Beiter A, Lillvis JH, Reynolds JD. Effect of low dose intravitreal bevacizumab and ranibizumab on regression and late reactivation in retinopathy of prematurity in treatment naïve eyes. Ophthalmol Retina. Published online December 27, 2021. doi:10.1016/j.oret.2021.12.016