The DOI matches its Crossref record; 45 of the 45 references it cites were found in a registry or an index.
Alternative treatments to inhibit VEGF in age-related choroidal neovascularisation: 2-year findings of the IVAN randomised controlled trial
Open accessAbstract
BACKGROUND: Bevacizumab has been suggested to have similar effectiveness to ranibizumab for treatment of neovascular age-related macular degeneration. The Inhibition of VEGF in Age-related choroidal Neovascularisation (IVAN) trial was designed to compare these drugs and different regimens. Here, we report the findings at the prespecified 2-year timepoint. METHODS: In a multicentre, 2×2 factorial, non-inferiority randomised trial, we enrolled adults aged at least 50 years with active, previously untreated neovascular age-related macular degeneration and a best corrected distance visual acuity (BCVA) of at least 25 letters from 23 hospitals in the UK. Participants were randomly assigned (1:1:1:1) to intravitreal injections of ranibizumab (0·5 mg) or bevacizumab (1·25 mg) in continuous (every month) or discontinuous (as needed) regimens, with monthly review. Study participants and clinical assessors were masked to drug allocation. Allocation to continuous or discontinuous treatment was masked up to 3 months, at which point investigators and participants were unmasked. The primary outcome was BCVA at 2 years, with a prespecified non-inferiority limit of 3·5 letters. The primary safety outcome was arterial thrombotic event or hospital admission for heart failure. Analyses were by modified intention to treat. This trial is registered, number ISRCTN92166560. FINDINGS: Between March 27, 2008, and Oct 15, 2010, 628 patients underwent randomisation. 18 were withdrawn; 610 received study drugs (314 ranibizumab; 296 bevacizumab) and were included in analyses. 525 participants reached the visit at 2 years: 134 ranibizumab in continuous regimen, 137 ranibizumab in discontinuous regimen, 127 bevacizumab in continuous regimen, and 127 bevacizumab in discontinuous regimen. For BCVA, bevacizumab was neither non-inferior nor inferior to ranibizumab (mean difference -1·37 letters, 95% CI -3·75 to 1·01; p=0·26). Discontinuous treatment was neither non-inferior nor inferior to continuous treatment (-1·63 letters, -4·01 to 0·75; p=0·18). Frequency of arterial thrombotic events or hospital admission for heart failure did not differ between groups given ranibizumab (20 [6%] of 314 participants) and bevacizumab (12 [4%] of 296; odds ratio [OR] 1·69, 95% CI 0·80-3·57; p=0·16), or those given continuous (12 [4%] of 308) and discontinuous treatment (20 [7%] of 302; 0·56, 0·27-1·19; p=0·13). Mortality was lower with continuous than discontinuous treatment (OR 0·47, 95% CI 0·22-1·03; p=0·05), but did not differ by drug group (0·96, 0·46-2·02; p=0·91). INTERPRETATION: Ranibizumab and bevacizumab have similar efficacy. Reduction in the frequency of retreatment resulted in a small loss of efficacy irrespective of drug. Safety was worse when treatment was administered discontinuously. These findings highlight that the choice of anti-VEGF treatment strategy is less straightforward than previously thought. FUNDING: UK National Institute for Health Research Health Technology Assessment programme.
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“However, in the IVAN study, the incidence was similar in eyes treated with ranibizumab (28%) and with bevacizumab (31%; p=0.46)”
From Five-Year Outcomes with Anti–Vascular Endothelial Growth Factor Treatment of Neovascular Age-Related Macular Degeneration (2016) · cites this paper as [9]
In the citing paper
“In CATT and all randomized clinical trials of anti-VEGF treatment for neovascular AMD, most of the improvement in mean visual acuity from baseline occurred within the first 3 to 6 months with little erosion of the benefit through 2 years when a fixed schedule of monthly (ranibizumab, bevacizumab, aflibercept) or bi-monthly (aflibercept) treatment was maintained.1,7,9,17,34”
From Five-Year Outcomes with Anti–Vascular Endothelial Growth Factor Treatment of Neovascular Age-Related Macular Degeneration (2016) · cites this paper as [9]
In the citing paper
“decreasing the likelihood of a true effect of ranibizumab on development of geographic atrophy.”
From Five-Year Outcomes with Anti–Vascular Endothelial Growth Factor Treatment of Neovascular Age-Related Macular Degeneration (2016) · cites this paper as [9]
In the citing paper
“In the IVAN study, 34% of eyes that received continuous (monthly) treatment developed geographic atrophy as compared with 26% in the discontinuous (PRN) group (p=0.03).9”
From Five-Year Outcomes with Anti–Vascular Endothelial Growth Factor Treatment of Neovascular Age-Related Macular Degeneration (2016) · cites this paper as [9]
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“6,12,13 Ranibizumab is the first intravitreal anti-VEGF licensed for nAMD.”
The Cost-Effectiveness of Ranibizumab Treat and Extend Regimen Versus Aflibercept in the UK
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“5 letters by 2 years, respectively.(5,7) Other outcome measures favored in clinical trials are the proportion of eyes gaining 15 ETDRS letters or more at different time points; in this study, 18% of first treated eyes and 6% of second treated eyes gained this at 2 years, compared with 30.”
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“This particular group of patients should be monitored closely and preferably treated with a pro re nata treatment regimen instead of a treat-and-extend or IVAN regimen, in which the risk of unnecessary injections should not be underrated [44,45].”
BackgroundEffect of bevacizumab on the expression of fibrosis-related inflammatory mediators in ARPE-19 cells
Chu, S.-J., Zhang, Z., Wang, M., & Xu, H. (2017) · International Journal of Ophthalmology · doi:10.18240/ijo.2017.03.07 · Cited by 14
STOLLER, G. L., Kokame, G. T., Dreyer, R. F., Shapiro, H., & Tuomi, L. L. (2016) · JAMA Ophthalmology · doi:10.1001/jamaophthalmol.2016.0379 · Cited by 14
Kiss, S., Liu, Y., Brown, J. G., Holekamp, N. M., Almony, A., Campbell, J. H., & Kowalski, J. W. (2014) · Ophthalmic surgery, lasers & imaging retina · doi:10.3928/23258160-20140709-04 · Cited by 15
Boxell, E., Amoaku, W. M. K., & Bradley, C. (2017) · BMJ Open · doi:10.1136/bmjopen-2016-012790 · Cited by 14
“In addition, the off-license use of bevacizumab (Avastin, Roche/Genentech) has been advocated by some specialists for the same indication since 2006(12) and has been found to have similar efficacy to ranibizumab.(13) In 1999, a nationwide survey was sent to members of the Macular Disease Society (now the Macular Socie…”
Background(DOG), D. O. G., (RG), R. G. E. V., & (BVA), B. D. A. D. E. V. (2020) · Der Ophthalmologe · doi:10.1007/s00347-020-01117-2 · Cited by 14
“Behandlungsserien in Abhängigkeit von der Läsionsaktivität („pro re nata“ [PRN]) PRN-Behandlungsarme in CATT- (Einzelinjektionen; [18,19]) und IVAN-Studie (3 Injektionen; [20,21]); nach Beendigung einer Be- Statement handlungsserie wird bei monatlichen Kontrollen in den nächsten 6 Monaten bei Aktivitätszeichen weiterb…”
InfluentialAmoaku, W. M. K., Gale, R. P., Lotery, A. J., Menon, G., Sivaprasad, S., Petrillo, J., & Quinn, J. (2015) · PLoS ONE · doi:10.1371/journal.pone.0128403 · Cited by 14
“The only available disease-specific instrument for measuring treatment satisfaction is the Macular Disease Treatment Satisfaction Questionnaire (MacTSQ) [9], which has been used in only one previous published trial [10].”
MethodResultSelf-citationSAVE-AMD: Safety of VEGF Inhibitors in Age-Related Macular Degeneration
Enseleit, F., Michels, S., Sudano, I., Stahel, M., Zweifel, S. A., Schlager, O., Becker, M. D., Winnik, S. H., Nägele, M. P., Flammer, A. J., et al. (2017) · Ophthalmologica · doi:10.1159/000478665 · Cited by 12
Horani, M., Mahmood, S., & Aslam, T. M. (2020) · Ophthalmology and Therapy · doi:10.1007/s40123-019-00227-8 · Cited by 13
Koizumi, H., Yamamoto, A., Ogasawara, M., Maruko, I., Hasegawa, T., Itagaki, K., Sekiryu, T., Okada, A. A., & Iida, T. (2020) · Japanese Journal of Ophthalmology · doi:10.1007/s10384-020-00745-0 · Cited by 13
Fallico, M., Lotery, A. J., Longo, A., Avitabile, T., Bonfiglio, V. M. E., Russo, A., Castellino, N., Parisi, G., Pulvirenti, A., Eandi, C. M., et al. (2020) · European Journal of Ophthalmology · doi:10.1177/1120672120964699 · Cited by 13
Self-citationCurcuma-Based Nutritional Supplement in Patients with Neovascular Age-Related Macular Degeneration
Allegrini, D., Raimondi, R., Angi, M., Ricciardelli, G., Montericcio, A., Borgia, A., & Romano, M. R. (2021) · Journal of Medicinal Food · doi:10.1089/jmf.2020.0199 · Cited by 14
“8,9 In this study, we evaluated the effects of a nutritional supplement (Macula 360; Doc, Italy) composed of 150 mg of curcumin ( curcuma longa l., rizoma), AREDS2 components , 4 mg astaxanthin (from haematococcus pluvialis flotow algae), and 20 mg resveratrol (from roots of polygonum cuspi-datum…”
Yin, X., He, T., Yang, S., Cui, H., & Jiang, W. (2022) · Journal of Immunology Research · doi:10.1155/2022/6004047 · Cited by 16
Thier, A., Breuning, M., Wolfram, C., Zeitz, O., & Holmberg, C. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-058266 · Cited by 16
Regulation of the pharmaceutical industry: promoting health or protecting wealth?
Maynard, A., & Bloor, K. E. (2015) · Journal of the Royal Society of Medicine · doi:10.1177/0141076814568299 · Cited by 13
Therapies in Development for Non-Infectious Uveitis
Sadiq, M. A., Agarwal, A. K., Hassan, M., Afridi, R., Sarwar, S., Soliman, M. K., Diana, V., & Nguyen, Q. D. (2015) · Current Molecular Medicine · doi:10.2174/1566524015666150731103847 · Cited by 13
Assessment of visual distortions in age-related macular degeneration: emergence of new approaches
Vazquez, N. P., & Knox, P. C. (2015) · British and Irish Orthoptic Journal · doi:10.22599/bioj.89 · Cited by 13
Kaynak, S., Kaya, M., & Kaya, D. (2018) · Turkish Journal of Ophthalmology · doi:10.4274/tjo.27448 · Cited by 13
Freiberg, F. J., Michels, S., Muldrew, A., Slakter, J. S., O’Shaughnessy, D., Czeszynski, A. D., Danielson, L., Jackson, T. L., & Chakravarthy, U. (2018) · British Journal of Ophthalmology · doi:10.1136/bjophthalmol-2018-311865 · Cited by 13
Self-citationLin, T., Dans, K., Müftüoğlu, İ. K., Meshi, A., Amador-Patarroyo, M. J., Cheng, L., & Freeman, W. R. (2019) · British Journal of Ophthalmology · doi:10.1136/bjophthalmol-2018-313447 · Cited by 13
“15–17 Although the CATT study demonstrated that the mean gain in visual acuity was greater for monthly than for as-needed treatment in year 2, there was no statistically significant difference in visual acuity or morphological outcomes between drug or regimen groups in year 5.”
BackgroundInfluentialIntravitreal therapy for retinal diseases in Norway 2011–2015
Kristiansen, I. S., Bråten, R. H., Jørstad, Ø. K., Moe, M. C., & Sæther, E. M. (2019) · Acta Ophthalmologica · doi:10.1111/aos.14262 · Cited by 13
“Bevacizumab is a VEGF antibody approved for several malignancies but has also been tested in several studies for retinal disease (CATT Research Group et al. 2011; Chakravarthy et al. 2013; Diabetic Retinopathy Clinical Research Network et al. 2015; Berg et al. 2016; Scott et al. 2017).”
BackgroundAnimalia nova sive species novae testudinum et ranarum .
von Spix, J. B. (1824) · Cited by 13
Nanji, K., Sarohia, G. S., Kennedy, K., Ceyhan, T., McKechnie, T., Phillips, M., Devji, T., Thabane, L., Kaiser, P. K., Sarraf, D., et al. (2021) · Ophthalmology · doi:10.1016/j.ophtha.2021.11.024 · Cited by 13
Nadeem, U., Xie, B., Movahedan, A., D’Souza, M., Barba, H., Deng, N., Leone, V. A., Chang, E., Sulakhe, D., & Skondra, D. (2020) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2020.10.01.318949 · Cited by 13
Hoven, E., Michelet, J.-T., Vettore, M. V., & Lagali, N. (2024) · Survey of Ophthalmology · doi:10.1016/j.survophthal.2024.09.011 · Cited by 12
Csincsik, L., Cheung, C. M. G., Bannon, F. J., Pető, T., & Chakravarthy, U. (2025) · American Journal of Ophthalmology · doi:10.1016/j.ajo.2025.01.011 · Cited by 12
Self-citationFoss, A. J. E., Almeida, D. R. P., Cheung, C. M. G., Ogura, Y., Cock, E. D., & Empeslidis, T. (2025) · Ophthalmology and Therapy · doi:10.1007/s40123-025-01093-3 · Cited by 15
Different Effects of Ranibizumab and Bevacizumab on Platelet Activation Profile
Sobolewska, B., Grimmel, C., Gatsiou, A., Sopova, K., Klein, J., Biedermann, T., Stellos, K., & Ziemssen, F. (2015) · Ophthalmologica · doi:10.1159/000437057 · Cited by 12
Navarro‐Partida, J., Altamirano-Vallejo, J. C., Aceves-Franco, L. A., González-Cortés, J. H., Mota, S. E. H.-D., García‐Aguirre, G., Azuara-Galindo, C. D., Castro‐Castañeda, C. R., Armendáriz‐Borunda, J., & Santos, A. (2021) · Pharmaceutics · doi:10.3390/pharmaceutics13091491 · Cited by 12
“Therefore, frequent intravitreal injections of ranibizumab are required to maintain the therapeutic effect and the visual outcomes [50, 51].”
Ranibizumab port delivery system in neovascular age-related macular degeneration
Chandrasekaran, P. R., & Madanagopalan, V. (2022) · Therapeutic Advances in Ophthalmology · doi:10.1177/25158414211072623 · Cited by 12
Intravitreal Bevacizumab in Retinopathy of Prematurity
Hapsari, D., & Sitorus, R. S. (2014) · Asia-Pacific Journal of Ophthalmology · doi:10.1097/apo.0000000000000039 · Cited by 12
“Recent findings from these studies indicated that both treatment yielded similar efficacy and safety profiles.(17,19,21,22) However, the 1-year findings of the Inhibition of VEGF in AgeRelated Choroidal Neovascularization randomized trial demonstrated that serum VEGF was significantly lower with bevacizumab compared t…”
BackgroundResultLai, K., Li, Y., Zhou, L., Zhong, X., Huang, C., Xu, F., Lü, L., Ge, J., & Jin, C. (2018) · BMC Ophthalmology · doi:10.1186/s12886-018-0801-7 · Cited by 12
Sangroongruangsri, S., Chaikledkaew, U., Kumluang, S., Wu, O., Geue, C., Ratanapakorn, T., Leelahavarong, P., Ingsrisawang, L., Ruamviboonsuk, P., Taweebanjongsin, W., et al. (2018) · Clinical Drug Investigation · doi:10.1007/s40261-018-0678-5 · Cited by 12
Sitnilska, V., Altay, L., Enders, P., Hermann, M. M., Muether, P. S., & Fauser, S. (2018) · Ophthalmologica · doi:10.1159/000492924 · Cited by 12
Differential effects of risuteganib and bevacizumab on AMD cybrid cells
Schneider, K., Chwa, M., Atilano, S. R., Shao, Z., Park, J. B., Karageozian, H. L., Karageozian, V. H., & Kenney, M. C. (2020) · Experimental Eye Research · doi:10.1016/j.exer.2020.108287 · Cited by 12
Current Management of Age-Related Macular Degeneration
Ung, C., Laíns, I., Miller, J. W., & Kim, I. K. (2021) · Advances in experimental medicine and biology · doi:10.1007/978-3-030-66014-7_12 · Cited by 12
Pennington, B., Alshreef, A., Flight, L., Metry, A., Poku, E. N., Hykin, P. G., Sivaprasad, S., Prevost, A. T., Vasconcelos, J. C., Murphy, C., et al. (2021) · PharmacoEconomics · doi:10.1007/s40273-021-01026-5 · Cited by 12
“Additionally, a large UK-based trial in age-related macular degeneration was inconclusive in comparing bevacizumab to ranibizumab using BCVA [44].”
BackgroundSelf-citationGarweg, J. G., Niderprim, S.-A., Russ, H. M., & Pfister, I. B. (2017) · Journal of Ocular Pharmacology and Therapeutics · doi:10.1089/jop.2017.0006 · Cited by 12
“2,3,11 This circumstance may explain why the outcomes in the T&E-arm of the TREX-study 22 differed so greatly from those in our own study.”
Lotery, A. J., & MacEwen, C. J. (2014) · BMJ · doi:10.1136/bmj.g6887 · Cited by 12
Self-citation
Metadata
- Authors
- Chakravarthy, U., Harding, S. P., Rogers, C. A., Downes, S. M., Lotery, A. J., Culliford, L. A., & Reeves, B. C.
- Affiliations
- Queen's University Belfast (GB)
- Corresponding author
- Chakravarthy, Usha
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2013-10
- Volume
- 382
- Issue
- 9900
- Pages
- 1258-1267
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2154073405
- Cited by
- 748
- References
- 45
- Citations by year
- 2026: 13 · 2025: 36 · 2024: 36 · 2023: 36 · 2022: 33 · 2021: 84 · 2020: 66 · 2019: 44 · 2018: 74 · 2017: 66 · 2016: 90 · 2015: 77 · 2014: 75 · 2013: 13
- FWCI
- 84.02
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Lancet (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- Research Portal (Queen's University Belfast) (submittedVersion, cc-by-nc-sa)
- Bristol Research (University of Bristol) (submittedVersion, cc-by-nc-sa)
- ePrints Soton (University of Southampton) (submittedVersion, cc-by-nc-sa)
- Funders
- National Institute for Health and Care Research (07/36/01)
- Health Technology Assessment Programme (07/36/01, /36/01)
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
- Health Sciences › Medicine › Ophthalmology › Retinal and Macular Surgery
- Keywords
- neovascular age-related macular degeneration, choroidal neovascularization, bevacizumab, ranibizumab, anti-VEGF therapy, intravitreal injection, treatment regimen comparison, best-corrected visual acuity, non-inferiority, arterial thrombotic events, long-term outcomes
- MeSH terms
- Bevacizumab, Ranibizumab, Aged, Female, Humans, Male, Middle Aged, Treatment Outcome, Choroidal Neovascularization, Angiogenesis Inhibitors, Vascular Endothelial Growth Factor A, Antibodies, Monoclonal, Humanized
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