The results of switching between 2 anti-VEGF drugs, bevacizumab and ranibizumab, in the treatment of neovascular age-related macular degeneration

Purpose: To report the results of switching from intravitreal bevacizumab to ranibizumab or vice versa in the treatment of choroidal neovascularization (CNV) due to age-related macular degeneration. Methods: Twenty eyes of 18 patients that underwent switch from intravitreal bevacizumab to ranibizumab and 10 eyes of 8 patients that underwent switch from ranibizumab to bevacizumab were retrospectively analyzed. The results were compared with 41 eyes of 37 patients treated with ranibizumab only. All eyes initially received 3 injections of ranibizumab or bevacizumab, which were repeated as needed (PRN dosing). Anti-vascular endothelial growth factor therapies were switched because of general health insurance applications and cost problems. The main outcome measures were best-corrected visual acuity (BCVA), injection number, and central macular thickness (CMT) obtained by optical coherence tomography. Results: Once all patients evaluated together at the final visit, the mean BCVA improved and CMT decreased. When switching groups were taken into consideration, switching yielded improved BCVA and reduced CMT following switching. After switching, BCVA continuously improved in the bevacizumab to ranibizumab group, but stayed stable in the ranibizumab to bevacizumab group. The CMT was reduced at the switching time in both groups, but did not change after the switch. Final visual acuity improved or stabilized in all eyes in the ranibizumab-only group. The BCVA worsened in 20% of eyes in the bevacizumab to ranibizumab group and in 40% of eyes in the ranibizumab to bevacizumab group. Conclusions: The ranibizumab-only group and the switching from bevacizumab to ranibizumab group seemed superior to the ranibizumab to bevacizumab group.