High-dose bevacizumab therapy may lead to less need for retreatment for ROP

Retinopathy of prematurity (ROP) is typically treated with intravitreal anti-VEGF medications, but repeated injections could potentially involve increased risk to the patient. This large-scale US study evaluated whether the dosage and choice of anti-VEGF medication impacted retreatment rates, the results suggesting that high-dose bevacizumab correlates with a significantly lower rate of retreatment than either low-dose bevacizumab or any dose of ranibizumab.

Study design

This was a US multicenter, retrospective, consecutive case series of patients who received anti-VEGF therapy for ROP. The study evaluated 567 eyes (307 patients) initially treated with bevacizumab (0.03–1.25 mg) or ranibizumab (0.15–0.3 mg), following them over a 15-year period to assess rates of retreatment based on anti-VEGF type or dosage.

Outcomes

Patients treated with ranibizumab consistently had higher rates of retreatment (58%) than those treated with bevacizumab (37%). Unlike the bevacizumab group, in which higher doses correlated with lower retreatment rates in a linear relationship, the rate of retreatment in the ranibizumab group was not dose-dependent. Compared with those in the no-retreatment group, patients who required retreatment had higher proportions of aggressive ROP (34% vs 18%, respectively) and zone 1 involvement (49% vs 34%, respectively).

Limitations

There may have been selection bias in the exclusion of patients who had laser retreatment, given that some patients could have been treated for prophylaxis, rather than reactivation of disease. Additionally, only ranibizumab and bevacizumab were compared in the study even though other anti-VEGF medications exist (i.e., aflibercept). With all patients being from the United States, confounding bias was reduced, but the study population may not accurately reflect global variation among patients with ROP or their care.

Clinical significance

It appears that high-dose bevacizumab treatment for ROP may require the least amount of retreatment compared to lower doses or treatment with ranibizumab. However, the long-term effects of higher doses of anti-VEGF agents are unknown. Finding the lowest effective dose is generally considered best practice in order to minimize unwanted side effects while maximizing drug impact. A larger prospective study is needed to further elaborate on these findings, including an analysis of risks associated with low-dose therapy followed by retreatment vs treating with higher initial doses.

Financial Disclosures: Dr. Rebecca Soares discloses no financial relationships.