Intravitreal administration of bevacizumab: pros and cons

Bevacizumab (Avastin®, Genethech, Inc.) is a humanized monoclonal antibody that inhibits vascular endothelial growth factor (VEGF). It was first approved by the US food and drug administration for metastatic colorectal cancer and subsequently for cervical/ovarian/fallopian tube cancers, glioblastoma, non-small cell lung cancer, and metastaic renal cell carcinoma [1]. Recently its offlabel use for age-related macular degeneration (AMD) has received extensive attention. Single dose vial of intravitreal ranibizumab (IVR), another anti-VEGF antibody, has been licensed for treatment of wet AMD and diabetic macular edema [1,2]. Due to lower cost and reported equall efficacy and safety data in large clinicat trials such as The Comparison of Age-related Macular Degeneration Treatment Trial (CATT), The Inhibitors of VEGF in Age-related Choroidal Neovascularization (IVAN) and GEFAL studies, intravitreal bevacizumab (IVB) has replaced the intravitreal administration of the approved drug ranibizumab [2-7]. A recent review on IVB administration for management of AMD and pathological myopathy concluded that despite promising results, short-term patients’ follow-up in the available studies, lack of well-designed extensive clinical trials, and insufficient data on safety of IVB make its use cautiously in these ocular diseases [8]. IVB administration has been widely used in other different proliferative retinopathies including retinopathy of prematurity [9,10] and diabetic retinopathy [9,11] as well. Angiogenesis with key regulator VEGF is the main pathology in these retinal and choroidal diseases [9]. A review on IVB administration for treatment of different aforementioned retinal and choroidal diseases showed promising reults [12].