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Are we there yet? Bevacizumab therapy for retinopathy of prematurity
  1. Brian A Darlow1,
  2. Anna L Ells2,
  3. Clare E Gilbert3,
  4. Glen A Gole4,
  5. Graham E Quinn5
  1. 1Department of Paediatrics, University of Otago, Christchurch, New Zealand
  2. 2Calgary Retina Consultants, Calgary, Canada
  3. 3International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
  4. 4Discipline of Paediatrics and Child Health, University of Queensland, Royal Children's Hospital, Brisbane, Australia
  5. 5Division of Ophthalmology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Professor Brian A Darlow, Department of Paediatrics, Christchurch School of Medicine and Health Sciences, University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand; brian.darlow{at}otago.ac.nz

Abstract

The publication of the BEAT-ROP study of bevacizumab (Avastin) treatment for Zone I and II retinopathy of prematurity (ROP) has raised hopes that there might now be a simpler, cheaper and more effective treatment than laser therapy, the current standard of care. However, we would urge caution at this point in time. We review the scientific background to the use of intravitreal anti-vascular endothelial growth factor for ROP, highlight a number of design issues in the BEAT-ROP study and problems with interpretation of the results. For example, no visual outcomes were reported and the study was underpowered to assess longer term safety. Intravitreal bevacizumab leaks into the systemic circulation in animals and adult humans and there are real concerns of potential harm to the developing preterm infant because vascular growth factors play a critical role in organogenesis. We conclude that bevacizumab should be reserved for exceptional circumstances and compassionate use pending further studies. Laser remains the proven effective therapy for first line treatment of all forms of ROP with little systemic morbidity. Neonatology and ophthalmology have an impressive record of conducting collaborative multicentre studies and we urgently need further rigorously designed, adequately powered randomised trials of anti-VEGF agents that evaluate visual outcomes as well as short and long term ocular and systemic safety.

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Footnotes

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.

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