Plasma Levels of VEGF Before and After Intravitreal Injection of Bevacizumab, Ranibizumab and Pegaptanib in AMD and DME Patients
In Austria, investigators sought to determine the level of vascular endothelial growth factor (VEGF) in the plasma of patients with diabetic macular edema (DME) and of patients with exudative age-related macular degeneration (AMD) before and after intravitreal injection of bevacizumab, ranibizumab or pegaptanib.
They included 30 patients with DME and 30 patients with AMD in this randomized, controlled study and randomized them to treatment with ranibizumab (0.5 mg), bevacizumab (1.25 mg) or pegaptanib (0.3 mg). A total of 10 patients with DME received bevacizumab, 10 ranibizumab and 10 pegaptanib. The same randomized treatment allocation applied to the 30 patients with AMD. The investigators measured the concentrations of VEGF by ELISA just before the injection, seven days after and one month after.
They reported that plasma VEGF in patients with exudative AMD before the injection of bevacizumab was 89.7 pg/ml and that it was significantly reduced to 25.1 pg/ml after seven days (p=0.01), and to 22.8 pg/ml after one month (p=0.008). In patients with DME, they observed the same systemic reduction by bevacizumab with a significant decrease of baseline VEGF level from 72.2 pg/ml to 13.7 pg/ml after seven days (p=0.008) and 17.1 pg/ml at four weeks with (p=0.012). They found no significant reductions of plasma VEGF in patients receiving ranibizumab or pegaptanib during follow-up.
In conclusion, bevacizumab significantly reduces the level of VEGF in the blood plasma for up to one month in patients with DME as well as in those with ARMD. No significant systemic effects of intravitreal ranibizumab or pegaptanib on plasma VEGF could be observed.