Work

Tachyphylaxis After Intravitreal Bevacizumab for Exudative Age-related Macular Degeneration

Year: 2009

Type: article

Abstract: In Brief Purpose: To describe tachyphylaxis to intravitreal bevacizumab (IVB) in patients with exudative age-related macular degeneration (AMD). Methods: We retrospectively reviewed the records of 59 consecutive patients treated with IVB at the National Eye Institute over a 14-month period and identified cases demonstrating loss of treatment efficacy as revealed by spectral domain optical coherence tomography. We defined tachyphylaxis as a loss of therapeutic response to IVB 28 ± 7 days after administration in an eye that had previously demonstrated a therapeutic response in the same time interval. Results: Five patients (six eyes) were identified as developing tachyphylaxis after repeated treatment with IVB. High-dose IVB (2.50 mg) did not restore therapeutic response in these patients. Bilateral tachyphylaxis to IVB was seen after an episode of unilateral postinjection anterior uveitis. After the first treatment of IVB, the median time taken to develop tachyphylaxis was 100 weeks (range: 31–128 weeks), and the median number of IVB treatments to the development of tachyphylaxis was 8 treatments (range: 5–10 treatments). Conclusion: Tachyphylaxis can occur after long-term intravitreal use of bevacizumab in patients with AMD. The precise mechanism of tachyphylaxis is unclear, but both local and/or systemic factors may be involved. Tachyphylaxis, described as a decrease in therapeutic drug response after repeated administration, was documented in five patients receiving multiple intravitreal bevacizumab injections for exudative age-related macular degeneration. The clinical features of the tachyphylactic response, the timeline of its emergence, and hypotheses concerning its pathogenesis are described in this report.

Source: Retina

DOI: 10.1097/iae.0b013e3181a2c1c3

Authors: FARZIN FOROOGHIAN, CATHERINE CUKRAS, CATHERINE B. MEYERLE, EMILY Y. CHEW, WAI T. WONG

Institutions: National Institutes of Health, National Eye Institute

Language: English

Topic: Retinal Diseases and Treatments

Subfield: Ophthalmology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: green

Funders: National Institutes of Health, National Eye Institute