Lower-dose bevacizumab may be effective in ROP treatment
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Bevacizumab at a lower than standard dose might be effective to treat severe retinopathy of prematurity and possibly reduce the risk for neurodevelopmental delay, according to a study.
Intravenous use of anti-VEGFs has become common practice to treat ROP, but concerns remain about possible adverse effects on the normal development of the brain, lungs, bones, kidneys and retina. The recommended dose of bevacizumab is currently between 0.25 mg and 0.625 mg, the latter being the dose that showed efficacy in the BEAT-ROP trial.

In a masked multicenter study, the Pediatric Eye Disease Investigator Group evaluated the possibility of achieving comparable efficacy in severe ROP using lower doses of the drug. Four doses were evaluated: 0.016 mg, 0.008 mg, 0.004 mg and 0.002 mg in groups of 10 to 14 infants with a follow-up of 4 weeks. Fifty-nine premature infants with ROP were enrolled between April 2017 and May 2019. Diluted bevacizumab was prepared by individual hospital pharmacies.

Success was defined as improvement by day 4 with no additional treatment for recurrence within 4 weeks.
A successful outcome was reported in 100% of the eyes receiving the 0.016 mg dose and 0.008 mg dose, 90% of the eyes receiving the 0.004 mg dose but only 74% of the eyes receiving the 0.002 mg dose, suggesting that 0.004 mg should be the lowest dose to be prescribed.

The authors said that further studies are needed to assess whether the efficacy of low-dose bevacizumab is sustained over time and to investigate the effects on plasma VEGF levels and peripheral retinal neovascularization in comparison with the standard higher doses and with laser photocoagulation.