However, the correlations between the above factors and the frequency of intravitreal injections were statistically significant only in visual acuity. Conclusions We recommend the combined therapy of bevacizumab and bromfenac as an alternative and beneficial method of treatment in patients with exudative AMD who do not qualify for ranibizumab therapy. of bevacizumab and bromfenac as an alternative and beneficial method of treatment in patients with exudative AMD who do not qualify for ranibizumab therapy. This combined therapy might efficiently reduce the number of intravitreal injections of bevacizumab. strong class=”kwd-title” MeSH Keywords: Anti-Inflammatory Agents, Non-Steroidal, Macular Degeneration, Vascular Endothelial Growth Factor, Endocrine-Gland-Derived Cephapirin Sodium Background According to the worldwide guidelines for the treatment of exudative age-related macular degeneration (AMD), the use of intravitreal injections of anti-VEGF agents, such as ranibizumab (Lucentis) or bevacizumab (Avastin), is regarded as the most common therapy. However, several researchers are in favor of additional topical non-steroidal anti-inflammatory drugs (NSAIDs), such as bromfenac [1,2]. Both ranibizumab and bevacizumab are humanized monoclonal IgG1 antibodies that inhibit VEGF, which is responsible for choroidal neovascularization [3,4]. While ranibizumab (Lucentis) is registered in Poland for the treatment of the wet form of AMD and is approved by the U.S. Food and Drug Administration for this indication, bevacizumab (Avastin) is licensed for the treatment of metastatic colon cancer, diffused breast cancer, advanced and diffused renal cancer, ovarian cancer, non-small-cell lung cancer, and glioblastoma multiforme [4C7]. However, anti-VEGF therapy with the application of Avastin also acts as an off-label therapy in Cephapirin Sodium the treatment of AMD. The most common regimen of the described approach refers to ranibizumab and is based on 3 initial monthly injections (the loading dose) [8]. The MARINA and ANCHOR Cephapirin Sodium clinical trials were the first studies in which the above scheme was found beneficial, although several limitations such as serious systemic adverse effects were mentioned. In the PIER clinical trial, loading dose was followed by quarterly injections depending on the CNV activity detected by optical coherence tomography (OCT), while the PrONTO Rabbit Polyclonal to FAF1 study revealed comparable results of visual acuity after 1 year of treatment, yet with half the number of injections. Therefore, new strategies leading to reduced injection frequency are the subject of experimental studies. For instance, it has been recently found that non-steroidal anti-inflammatory drugs can also play a major role in ophthalmology, especially in the treatment of exudative AMD [9]. The application of NSAIDs is based on their ability to suppress prostaglandin-induced inflammation, which is linked to the development and maintenance of choroidal neovascularization [10]. Bromfenac belongs to the class of non-steroidal anti-inflammatory agents, which suppress the production of prostaglandins by Cephapirin Sodium inhibiting cyclooxygenase (COX), the enzyme responsible for the conversion of arachidonic acid to cyclic endoperoxides, which are precursors Cephapirin Sodium of prostaglandins. Bromfenac and other nonsteroidal anti-inflammatory drugs are approved for the treatment of inflammation after cataract surgery. Retinal levels have also been investigated after topical administration and were found to be within the therapeutic index [11]. Recent research on possible co-factors in pathogenesis of diabetic macular edema and AMD has shown that anti-VEGF agents and anti-inflammatory drugs are not the only participants in the therapeutic process. Specifically, Das states that lipoxins A4, resolvins, and protectins may prevent the development and progression of the disease. According to Das, these anti-inflammatory compounds derived from omega-3 fatty acids could be administered intravitreally. He also reports that this alternative therapy seems to be safer and less toxic [12,13]. The results of many studies reveal that due to the combined therapy, the number of injections can be limited throughout the year. Most trials evaluated intravitreal ranibizumab and topical bromfenac, and little is known about other anti-VEGF agents in the combination of NSAIDs. Therefore, the aim of our study was to evaluate the combined.
