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Systemisches und intravitreales Bevacizumab (Avastin®) bei neovaskulärer altersbezogener Makuladegeneration

Systemic and intravitreal Bevacizumab (Avastin®) in neovascular age-related macular degeneration

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Summary

A number of experimental and clinical studies have show the important role of the vascular endothelial growth factor (VEGF) in most neovascular and exudative ocular diseases. The therapeutic concept of an anti-VEGF therapy has been most promising in a number of prospective controlled clinical trials. In the treatment of neovascular age-related macular degeneration (AMD) intravitreal anti-VEGF therapy has shown not only to stabilize vision in most patients, but also to improve vision in a significant number of patients. Bevacizumab (Avastin®) is a monoclonal antibody designed to bind all isoforms of VEGF. It has been primarily developed for the systemic treatment of colon cancer in oncology. But several prospective and retrospective case series evaluating the use of systemic and intravitreal bevacizumab in neovascular AMD and other neovascular and exudative ocular diseases have shown most promising results. Despite the fact that results of large, prospective, long-term studies are currently unavailable, a number of studies have shown anatomic, functional and safety results up to 6 months similar to other anti-VEGF drugs. An approval of bevacizumab in ophthalmology by regulatory agencies cannot be expected in the near future. Similar to a number of drugs in clinical use, bevacizumab will remain available in ophthalmology only as off label treatment or in clinical trials. To clarify the role of bevacizumab for the treatment of a number of neovascular and exudative eye diseases, prospective long-term studies are necessary.

Zusammenfassung

Die wichtige Rolle des vaskulären endothelialen Wachstumsfaktors (VEGF) bei vielen neovaskulären und exsudativen Erkrankungen des Auges hat sich in den letzten Jahren in zahlreichen experimentellen und klinischen Studien herausgestellt. Das therapeutische Konzept der Anti-VEGF-Therapie zeigte sich in zahlreichen prospektiven, kontrollierten Studien mit unterschiedlichen Anti-VEGF-Präparaten als viel versprechend. Besonders bei der neovaskulären altersbezogenen Makuladegeneration (AMD) scheint es möglich geworden zu sein, nicht nur den Visusverlust zu verlangsamen, sondern in einem nicht unerheblichen Anteil der Patienten eine Visusverbesserung zu erreichen. Bevacizumab (Avastin®) ist ein monoklonaler Antikörper, der alle Isoformen des VEGF bindet. Er wurde primär für die systemische Therapie in der Onkologie entwickelt. Prospektive und retrospektive Fallserien zur systemischen und intravitrealen Anwendung von Bevacizumab bei der neovaskulären AMD aber auch bei anderen neovaskulären und exsudativen Erkrankungen des Auges haben sehr viel versprechende Ergebnisse bei insgesamt gutem Sicherheitsprofil gezeigt. Es ist jedoch nicht davon auszugehen, dass Bevacizumab in nächster Zukunft eine Zulassung für die Anwendung in der Augenheilkunde erhalten wird. Wie bei vielen anderen Präparaten in der Augenheilkunde wird die Behandlung mit Bevacizumab weiterhin nur off label oder in klinischen Studien möglich sein. Um die Rolle von Bevacizumab bei der Behandlung verschiedener Augenerkrankungen abschließend bewerten zu können, bleiben jedoch prospektive Langzeitstudien abzuwarten.

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Authors and Affiliations

  1. Klinik für Augenheilkunde und Optometrie, Medizinische Universität Wien, Austria

    S. Michels, F. Prager, W. Geitzenauer, B. Lackner, S. Sacu, G. Weigert, K. Kriechbaum, K. Polak, M. Georgopoulos & U. Schmidt-Erfurth

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  1. S. Michels
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  2. F. Prager
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  3. W. Geitzenauer
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  4. B. Lackner
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  5. S. Sacu
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  6. G. Weigert
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  7. K. Kriechbaum
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  8. K. Polak
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  9. M. Georgopoulos
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  10. U. Schmidt-Erfurth
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Correspondence to S. Michels.

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Michels, S., Prager, F., Geitzenauer, W. et al. Systemisches und intravitreales Bevacizumab (Avastin®) bei neovaskulärer altersbezogener Makuladegeneration. Spektrum Augenheilkd. 21, 154–159 (2007). https://doi.org/10.1007/s00717-007-0203-3

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  • DOI: https://doi.org/10.1007/s00717-007-0203-3

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