Endophthalmitis Risk May Not Be Higher With Bevacizumab After All

Ophthalmic injections of bevacizumab exhibited no greater risk of endophthalmitis than injections of ranibizumab, according to a new study published in JAMA Ophthalmology.

Researchers from the University of Pennsylvania analyzed insurance claims data from 2005–2012 across the country in response to cases of bevacizumab-related endophthalmitis. The reports prompted the Food and Drug Administration (FDA) to propose significant restrictions on its use for eye disorders. Senior author Brian L. VanderBeek, MD, MPH, noted that bevacizumab may actually have a lower endophthalmitis risk than ranibizumab.

Study authors found cases of endophthalmitis in 49 out of the 296,565 bevacizumab injections and 22 cases out of 87,245 ranibizumab injections. The 35% lower rate seen among bevacizumab injections was not statistically significant but the researchers state that the findings appear to show that repackaged bevacizumab does not contribute a greater endophthalmitis risk than ranibizumab packaged by the manufacturer.

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Bevacizumab is an angiogenesis inhibitor that targets the VEGF blood vessel growth factor. Ophthalmologists began using bevacizumab "off-label" to treat common age- and diabetes-related retinal diseases such as wet macular degeneration since it also results from VEGF-driven processes. Compounding pharmacies had often repackaged bevacizumab into smaller doses more appropriate for the eyes. In 2007, Genentech announced the block of ophthalmic use of bevacizumab by prohibiting sales to compounding pharmacies; however, they reversed their stance after strong protests from some healthcare professionals. Then in 2012, there were reports of endophthalmitis outbreaks following the repackaged bevacizumab injections. The FDA then announced in February of 2015 the restriction of bevacizumab's ophthalmic use to the five-day period following the repackaging of the drug by a compound pharmacy.

For more information visit med.upenn.edu.

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