AAO: Triple Therapy Leads to Lasting Improvement in Macular Degeneration

NEW ORLEANS, Nov. 13 -- For many patients with choroidal neovascularization from age-related macular degeneration, a single cycle of photodynamic therapy, bevacizumab (Avastin), and intravitreal steroids led to sustained improvement in visual acuity, German investigators reported here.
Action Points
Explain to interested patients that one course of combination therapy with three forms of treatment has shown promise for producing lasting improvement in macular degeneration.
Note that the therapy was used in Germany and might not be consistent with treatment approaches in the U.S.
Note also that the findings were reported at a medical conference and as a published abstract and should be considered preliminary until they have appeared in a peer-reviewed journal.
After a mean follow-up of 62 weeks, improvement in visual acuity for 104 eyes in 104 patients averaged 2.1 lines (P<0.01), Albert J. Augustin, M.D., of Karlsruhe Clinic in Karlsruhe, Germany, reported at the American Academy of Ophthalmology meeting here.
Retinal thickness also decreased significantly (P<0.01).
Triple therapy was well tolerated, no severe systemic or optical adverse effects occurred, and intraocular pressure did not increase, he added.
"Ultimately, we must tailor therapy to suit the individual's disease characteristics, ability to visit the clinic, and treatment preference or feasibility," Dr. Augustin concluded.
Age-related macular degeneration has a multifactorial pathogenesis that involves hypoxia, oxidative pressure, inflammatory responses, and an altered balance of pro- and antiangiogenic factors that results in neovascularization, Dr. Augustin noted. An ideal therapy, he said, would include an antiangiogenic agent, an anti-inflammatory, and photodynamic therapy to treat existing choroidal neovascularization.
Dr. Augustin and colleagues have used triple therapy in more than 400 patients, and he reported results for patients who have been followed the longest. Treatment consisted of 70-second photodynamic therapy with verteporfin, followed an average of 16 hours later by intravitreal administration of 800 µg of dexamethasone and 1.5 mg of bevacizumab.
In addition to the improvement in visual acuity, retinal thickness decreased by an average of 195 µm. Five patients required a second cycle of therapy because of persistent choroidal neovascularization activity. Additionally, 23 patients (22%) received a second injection of bevacizumab.
The triple therapy results in significant and sustained improvement in visual acuity, has a good safety profile, is convenient for patients, and is cost-effective over time as compared with indefinite therapy, such as an anti-VEGF agent, Dr. Augustin concluded.
Dr. Augustin disclosed investigator and consultant relationships with Alcon, Allergan, Novartis, Pfizer, and QLT Phototherapeutics.Primary source: American Academy of OphthalmologySource reference: Augustin AJ, "Triple therapy: bevacizumab + photodynamic therapy + steroids" AAO Meeting 2007; Subspecialty Program -- Retina: 40-42.