IVAN, GEFAL: Two anti-VEGFs ‘equivalent’

Seattle-Ranibizumab and bevacizumab appear to be equally effective for the treatment of age-related macular degeneration (AMD). The results of two large randomized multicenter trials-the IVAN and GEFAL-found that both drugs had similar effects on vision acuity and lesion morphology.

In addition, the IVAN trial found that a continuous drug regimen was slightly more favorable than a discontinuous one (patients receive three monthly injections and are then monitored monthly for the remainder of the 2-year study period).

A meta-analysis, in which the data from the IVAN trial was included, also confirmed the initial results, said Simon Harding, FRCOphth, MD, professor, Head of Department, Department of Eye and Vision Science at Royal Liverpool University Hospital, England.

Both the IVAN and GEFAL studies compared ranibizumab (Lucentis, Genentech) and bevacizumab (Avastin, Genentech) in a “head-to-head” comparison of their efficacy and safety. In addition, IVAN also compared continuous and discontinuous treatment regimens.

“Bevacizumab was found to be non-inferior to ranibizumab,” Dr. Harding said. “The key message is that the drugs have similar efficacy, and continuous therapy has slightly better efficacy.”

However, while there was no difference for the two drugs in geographic atrophy, it occurred at a lesser rate in the discontinuous group (33% versus 26% less OR 1.47).

“But there were significantly more deaths in the discontinuous groups, and the meta-analyses showed more serious adverse events,” Dr. Harding said. “So while there is an increased risk of geographic atrophy in the continuous group, this increase in death rate should be given more weight over geographic atrophy.”

The results from the GEFAL study was similar to IVAN, for both the individual trial and the meta-analysis which was also conducted.

“The take-home message is that both drugs were equivalent for visual acuity at the final evaluation, both drugs produced rapid and substantial decreases in thickness and fluid, and neither drug eliminated fluid in all eyes,” said Laurent Kodjikian, MD, PhD, of the Croix-Rousse University Hospital, Lyon, France. “There was no statistical difference in dye leakage on fluorescein angiography, and a slight decrease in choroidal neovascularization with both drugs.”

The meta-analysis put the GEFAL in perspective, Dr. Kodjikian said. “The GEFAL results are in concordance with those of previous studies.”

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