Bevacizumab versus Ranibizumab in Treating Retinopathy of Prematurity
Authors: Tianwei Ellen Zhou 1, Kamini Raghuram1, Elizabeth Asztalos1, Rudaina Banihani1, Kamiar Mireskandari1, Nasrin Tehrani1, Kenneth Eng1, Radha Kohly1, Ugo Dodd2, Kamran Yusuf2, Prakesh Shah,1, Linh Ly1, Anna Ells1, Peter Kertes1. 1University of Toronto, 2University of Calgary.
Author Disclosures: T.E. Zhou: Funded grants or Clinical Trials; Name of for-profit or not-for-profit organization(s); Fighting Blindness Canada - Clinician-Scientists Emerging Leaders Award. K. Raghuram: None. E. Asztalos: None. R. Banihani: None. K. Mireskandari: None. N. Tehrani: None. K. Eng: None. R. Kohly: None. U. Dodd: None. K. Yusuf: None. P. Shah,: None. L. Ly: None. A. Ells: None. P. Kertes: None.
Abstract Body:
Purpose: Retinopathy of prematurity (ROP) remains the dominant cause of severe visual impairment in childhood worldwide. Intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents has become the mainstay treatment for ROP in the past 15 years. Intravitreal bevacizumab (IVB) and ranibizumab (IVR) are the 2 most commonly used anti-VEGF agents for ROP.Although they both neutralize the effects of VEGF, their different molecular structures confer different pharmacodynamic and pharmacokinetic properties. When choosing between the 2 molecules, the dilemma has been that while bevacizumab seems to be more effective in treating ROP with a lower likelihood of recurrent disease based on small case series but is also more likely to leak into the systemic circulation and may suppress the healthy level of circulating VEGF. For this reason, there remains the concern that bevacizumab may have a detrimental effect on neurodevelopmental outcomes. So far, a head-to-head comparison between IVB and IVR is still lacking in the literature.
Study Design: This is a multi-centre, retrospective, cross-sectional and comparative study. All infants treated and/or followed up at the Hospital for Sick Children, Sunnybrook Health Sciences Centre, Mount Sinai Hospital and the University of Calgary hospitals between 2015-2021 for type 1 ROP with IVB or IVR were included.
Methods: After the initial treatment (either IVB or IVR), our patients were followed up in their respective hospitals to ensure a complete regression of ROP and to detect reactivation of the disease. The reactivation of ROP has been formally defined by ICROP 3. All sites conducted 18-24 months and/or 36 months neurodevelopmental assessments. In addition, the local copies of the Canadian Neonatal Network (CNN) and the Canadian Neonatal Follow-up Network (CNFUN) databases will be utilized for this study.
Results: This study is ongoing. Results from this project are anticipated to be available by April - May 2023.
Conclusions: This is the first study in North America to directly compare the efficacy and neurodevelopmental outcomes of IVB and IVR in treating ROP. These data are highly valuable as they help ophthalmologists decide on the best medication for this vulnerable population.
