RESUMEN
PURPOSE: To investigate the safety and efficacy of ranibizumab for the treatment of choroidal neovascularization (CNV) secondary to causes other than age-related macular degeneration (AMD). DESIGN: Multicenter, randomized, 12-month clinical trial. PARTICIPANTS: Thirty patients with CNV due to causes other than AMD, including pathologic myopia, ocular histoplasmosis, and angioid streaks. METHODS: Participants were randomly assigned 1:1 to monthly intravitreal injections of 0.5 mg ranibizumab or 3 monthly injections followed by dosing as needed (pro re nata [PRN]) at monthly follow-up visits. MAIN OUTCOME MEASURES: Outcome measures included the incidence of ocular and nonocular adverse events, the percentage of patients gaining ≥ 15 letters of visual acuity (VA) at 6 and 12 months from baseline, the percentage of patients losing ≥ 15 letters of VA at 6 and 12 months from baseline, and mean change in VA and central retinal thickness (CRT) at 6 and 12 months from baseline. RESULTS: No serious ocular or systemic adverse events related to ranibizumab or the injection procedure were reported. Among patients who received monthly ranibizumab injections, 8 of 12 (66.7%) gained ≥ 15 letters of VA at both 6 and 12 months, and among patients who received PRN injections, 9 of 14 (64.3%) and 8 of 14 (57.1%) gained ≥ 15 letters of VA at 6 and 12 months, respectively. No patient in the study lost ≥ 15 letters of VA. Mean VA improved significantly from baseline by 23.9 ± 5.4 (P = 0.001) and 21.1 ± 4.3 letters (P = 0.0003) at 6 months and by 26.9 ± 5.3 (P = 0.0003) and 19.2 ± 3.8 letters (P = 0.0002) at 12 months in the monthly and PRN treatment arms, respectively. Mean CRT decreased significantly from baseline by 103.4 ± 18.9 (P = 0.0005) and 161.1 ± 43.7 µm (P = 0.0034) at 6 months and by 109.3 ± 19.5 (P = 0.0004) and 166.6 ± 38.4 µm (P = 0.001) at 12 months in the monthly and PRN treatment groups, respectively. No statistically significant difference was found between treatment groups in change in VA or CRT at any time point. CONCLUSIONS: Intravitreal ranibizumab, given as monthly injections or as 3 monthly injections followed by PRN dosing, showed a promising efficacy and safety profile in the treatment of CNV due to causes other than AMD.
Asunto(s)
Inhibidores de la Angiogénesis/administración & dosificación , Estrías Angioides/complicaciones , Anticuerpos Monoclonales/administración & dosificación , Neovascularización Coroidal/tratamiento farmacológico , Histoplasmosis/complicaciones , Miopía Degenerativa/complicaciones , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Adulto , Anticuerpos Monoclonales Humanizados , Neovascularización Coroidal/etiología , Neovascularización Coroidal/fisiopatología , Femenino , Angiografía con Fluoresceína , Humanos , Inyecciones Intravítreas , Masculino , Persona de Mediana Edad , Ranibizumab , Tomografía de Coherencia Óptica , Resultado del Tratamiento , Agudeza Visual/fisiologíaRESUMEN
OBJECTIVE: To evaluate the biologic activity of multiple intravitreal injections of ranibizumab in patients with center-involving clinically significant diabetic macular edema (DME) and to report any associated adverse events. DESIGN: Single-center, open-label, dose-escalating pilot study. PARTICIPANTS: A total of 10 eyes of 10 patients (mean age, 69.3 years [range, 59-81]) with DME involving the center of the macula and best-corrected visual acuity (BCVA) in the study eye between 20/63 and 20/400. INTERVENTION: Three intravitreal injections of ranibizumab (0.3 mg or 0.5 mg each injection) administered on day 0, month 1, and month 2, and observation until month 24. MAIN OUTCOME MEASURES: Primary end points were the frequency and severity of ocular and systemic adverse events. Secondary end points were BCVA and measurement of retinal thickness by optical coherence tomography. RESULTS: Of the 10 patients enrolled, 5 received 0.3-mg and 5 received 0.5-mg ranibizumab. Intravitreal injections of ranibizumab were well tolerated. No systemic adverse events were reported. Five occurrences of mild to moderate ocular inflammation were reported. At month 3, 4 of 10 patients gained > or =15 letters, 5 of 10 gained > or =10 letters, and 8 of 10 gained > or =1 letters. At month 3, the mean decrease in retinal thickness of the center point of the central subfield was 45.3+/-196.3 microm for the low-dose group and 197.8+/-85.9 microm for the high-dose group. CONCLUSIONS: Ranibizumab appears to be a well-tolerated therapy for patients with DME. This pilot study demonstrates that ranibizumab therapy has the potential to maintain or improve BCVA and reduce retinal thickness in patients with center-involved clinically significant DME.