Background Bevacizumab is an anti-vascular endothelial growth factor monoclonal antibody. Its off-label use has increased in the management of a variety of ophthalmology diseases.
Purpose The aim of this study was to analyse the off-label use of bevacizumab, outside of oncology indications, in the department of ophthalmology, in the Specialty Hospital of Rabat.
Material and methods Retrospective observational study including all ophthalmology patients under bevacizumab treatment between January 2017 and August 2018. Collected data were demographic- and treatment-related, the data were gathered from the medical records and from the pharmacy software.
Results Eighty-five patients (68.5% females, average age 62.66±13 years) received intravitreal administration of bevacizumab in hospital (100 mg/4 ml). The dose used was 2.5 mg (0.1 ml). All of the injections used were off-label.
Off-label indications identified were 65% (64/85) of diabetic macular oedema (DME), 20% (10/85) of age-related macular degeneration (AMD) and 15% (11/85) of macular oedema secondary to retinal vein occlusion (RVO). On average, 5±1.53 injections were used to treat DME, 10±2.15 injections for AMD and 7±3.42 injections for RVO.
The course of the disease was assessed by optical coherence tomography examination, which showed a 75% improvement in patients treated for DME, 60% of patients with OVR and 40% of patients with AMD.
During the study period, 32 vials were used to treat 85 patients (786 injections), on average 25 injections per vial (37.5% of volume lost per vial). Each vial cost €230. If the corresponding number of vials had been used, the total cost would have been €7360.
Cost per patient were €46 (DME), €92 (AMD) and €65 (RVO). Cost per diseases were €2944 (DME), €920 (AMD) and €708 (RVO).
Compared to Lucentis (ranibizumab), has a label use for these pathologies. The cost differences are significant at about €6 per injection for Avastin and €800 per injection for Lucentis.
Conclusion The off-label use of bevacizumab appears to be useful as a salvage treatment for ocular diseases. The high economic impact makes it necessary to rationalise bevacizumab prescription and to prepare a pre-filled syringe in the pharmacy to prevent loss of volume and to reduce the risk of infection.
References and/or acknowledgements No conflict of interest.
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