A Dosing Study of Bevacizumab for Retinopathy of Prematurity: Late Recurrences and Additional Treatments

Purpose Intravitreal bevacizumab is increasingly used to treat severe retinopathy of prematurity (ROP), but it enters the bloodstream, and there is concern that it may alter development of other organs. Previously we reported short-term outcomes of 61 infants enrolled in a dose de-escalation study, and we report the late recurrences and additional treatments. Design Masked, multicenter, dose de-escalation study. Participants A total of 61 premature infants with type 1 ROP. Methods If type 1 ROP was bilateral at enrollment, then the study eye was randomly selected. In the study eye, bevacizumab intravitreal injections were given at de-escalating doses of 0.25 mg, 0.125 mg, 0.063 mg, or 0.031 mg; if needed, fellow eyes received 1 dose level higher: 0.625 mg, 0.25 mg, 0.125 mg, or 0.063 mg, respectively. After 4 weeks, additional treatment was at the discretion of the investigator. Main Outcome Measures Early and late ROP recurrences, additional treatments, and structural outcomes after 6 months. Results Of 61 study eyes, 25 (41%; 95% confidence interval [CI], 29%–54%) received additional treatment: 3 (5%; 95% CI, 1%–14%) for early failure (within 4 weeks), 11 (18%; 95% CI, 9%–30%) for late recurrence of ROP (after 4 weeks), and 11 (18%; 95% CI, 9%–30%) for persistent avascular retina. Re-treatment for early failure or late recurrence occurred in 2 of 11 eyes (18%; 95% CI, 2%–52%) treated with 0.25 mg, 4 of 16 eyes (25%; 95% CI, 7%–52%) treated with 0.125 mg, 8 of 24 eyes (33%; 95% CI, 16%–55%) treated with 0.063 mg, and 0 (0%; 95% CI, 0%–31%) of 10 eyes treated with 0.031 mg. By 6 months corrected age, 56 of 61 study eyes had regression of ROP with normal posterior poles, 1 study eye had developed a Stage 5 retinal detachment, and 4 infants had died of preexisting medical conditions. Conclusions Retinal structural outcomes are very good after low-dose bevacizumab treatment for ROP, although many eyes received additional treatment.