TACHYPHYLAXIS AFTER INTRAVITREAL BEVACIZUMAB FOR EXUDATIVE AGE-RELATED MACULAR DEGENERATION
Open accessAbstract
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.
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Reduced response, presumed tachyphylaxis, may occur as early as after 2 anti-VEGF injections, while others occurred after 10 injections.
“It has been suggested that reduced response, presumed 'tachyphylaxis' may occur as early as after 2 anti-VEGF injections while others occurred after 10 injections.45,[55][56][57][58][59]”
From Defining response to anti-VEGF therapies in neovascular AMD (2015) · cites this paper as [56]
The Results report tachyphylaxis after as many as 10 intravitreal bevacizumab treatments, supporting the upper end of the cited range. They do not report onset after 2 injections: the lowest count given is 3 treatments when counting only the affected eye. Page numbers are unavailable in our copy. (LLM, conf=0.90)
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- Authors
- FOROOGHIAN, F., CUKRAS, C., MEYERLE, C. B., CHEW, E. Y., & WONG, W. T.
- Affiliations
- National Institutes of Health (US)
- Corresponding author
- FOROOGHIAN, FARZIN
- CUKRAS, CATHERINE
- MEYERLE, CATHERINE B.
- CHEW, EMILY Y.
- Venue
- Retina
- Published
- 2009-06
- Volume
- 29
- Issue
- 6
- Pages
- 723-731
- ISSN
- 0275-004X (ISSN-L)
- PMC
- PMC2770842
- OpenAlex
- W1976005612
- Cited by
- 179
- References
- 19
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 6 · 2023: 8 · 2022: 6 · 2021: 14 · 2020: 10 · 2019: 7 · 2018: 7 · 2017: 16 · 2016: 21 · 2015: 25 · 2014: 14 · 2013: 13 · 2012: 6
- FWCI
- 8.13
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Retina (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (Z99 EY999999)
- National Eye Institute (ZIEEY000487)
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal and Macular Surgery
- Keywords
- tachyphylaxis, bevacizumab, intravitreal injection, neovascular age-related macular degeneration, anti-VEGF therapy, pathogenesis
- MeSH terms
- Bevacizumab, Aged, Aged, 80 and over, Antibodies, Monoclonal, Exudates and Transudates, Female, Humans, Injections, Macular Degeneration, Male, Retrospective Studies, Tachyphylaxis, Vitreous Body, Retreatment, Angiogenesis Inhibitors, Tomography, Optical Coherence, Vascular Endothelial Growth Factor A, Antibodies, Monoclonal, Humanized
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