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Delayed wound healing after retinal surgery may be a side effect associated with this chemotherapy. Several drug candidates are showing promise, with plenty more in the works. Editorially independent content supported with advertising by Regeneron. The future remains bright with many clinical trials reporting promising data. Baumal, MD. A careful examination is necessary to properly diagnose iridocorneal endothelial syndrome with iris nevus.
Mallory E. Shields, MD. Donald J. Rosenfeld: In our practice right now, we use ranibizumab and bevacizumab interchangeably. We just finished analyzing our outcomes retrospectively and found no statistical difference between the medications.
We won't know how these drugs compare until a prospective comparative study is performed, but we know enough to have an intelligent discussion with our patients and lay out what we know and don't know about the safety, efficacy and economic impact of these treatments. Therefore, we feel very comfortable moving between the drugs, depending on the patient's financial situation, their understanding of the drugs, their prior experience with either drug and their desire to take cost of therapy into consideration.
Hariprasad: Before the FDA approved ranibizumab, we frequently used bevacizumab with excellent efficacy. Rosenfeld: What do you discuss with patients regarding the potential side effects of anti-VEGF therapy? Reichel: I explain to patients why I use the 0. I tell them that according to some very preliminary data from the Phase 3b SAILOR study a risk of stroke may be associated with the higher dose. Rosenfeld: It is important to note that a risk of stroke exists for both doses, and outcomes with the 0.
These interim SAILOR results are far too preliminary to draw any conclusions yet, and the FDA hasn't recommended any change in the label or the clinical practice recommendations. Even if we assume these preliminary results hold up at 1 year, do you think there really is a difference in terms of potential side effects between selective VEGF blockade treatments, ie, pegaptanib sodium Macugen, [OSI] Eyetech and nonselective VEGF blockade ie, ranibizumab and bevacizumab?
Reichel: I do not think we have enough data to make that determination. However, in looking just within the ranibizumab data, there is something suggestive of risk with the 0.
Whether it is for thromboembolic or hemorrhagic events, we may be seeing a trend. Brown: We are treating with the 0. The phase 3 ranibizumab data did not reveal a safety signal. In terms of selective vs. The only time I emphasize the possible risk for thromboembolic events is when a patient has had a previous stroke.
I tell the patient that the potential risk exists, and we will try to minimize it by using the least possible number of injections.
Then, it is up to the patient and his family. I have many patients who are willing to take the risk if their vision is declining. Other patients would rather have PDT. Apte: I use the 0. Based on the animal and in vitro data, there may be a theoretical difference in risk between the selective and nonselective anti-VEGF agents.
But none of the clinical trials to date has shown a significant difference in systemic safety profile. We have to compare apples to apples before concluding that nonselective anti-VEGF agents are less safe than selective agents. At this time, I treat with the 0. If a patient is sick, having a history of stroke in the past 6 months or a recent myocardial infarction, I engage in a more careful discussion than I do with a healthy elderly patient who needs ranibizumab treatment.
Since patients with prior strokes were excluded from the pegaptanib trials, we really don't know if pegaptanib is any safer. Fluorescein angiography also can help to determine why a patient who was expected to do well with treatment suddenly is not doing well. Perhaps in this era of prn treatment, fluorescein angiography can add to our knowledge in cases where we would like to increase the interval between treatments because the retina appears to be dry on OCT.
Apte, MD, PhD. At baseline, fluorescein angiography gives me a good geographic overview of what is going on in the macula.
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