LUCAS: Lucentis Compared to Avastin Treat and Extend Study For Macular Degeneration

Karina Birgitta Berg MD Department of Ophthalmology Oslo University Hospital Oslo, Norway

Dr. Berg Interview with:
Karina Birgitta Berg MD
Department of Ophthalmology
Oslo University Hospital
Oslo, Norway 

Medical Research: What is the background for this study? What are the main findings?

Dr. Berg: Neovascular age-related macular degeneration (nAMD) has been the leading cause of vision loss in the elderly population of Western countries. Inhibition of vascular endothelial growth factor (VEGF) with medications such as bevacizumab and ranibizumab injected into the eye, has dramatically reduced the incidence of social blindness from this disease. Bevacizumab was marketed for intravenous cancer treatment, while ranibizumab was later developed and approved for intraocular treatment of nAMD. Due to similar clinical effects and a strikingly low cost compared to ranibizumab, bevacizumab has remained widely used as an off-label treatment for the treatment of nAMD. In order to preserve vision results over time, most patients need injections repeatedly. Treatment on a monthly basis has shown good vision improvement, while monitoring monthly and treating only when signs of recurrences appear, is less successful. The aim of a treat-and-extend protocol is to gradually increase the treatment intervals, while avoiding potentially harmful recurrences. This treatment modality has become commonly used, entailing fewer patient visits and less burden upon health care systems.

The multicenter prospective randomized Lucentis Compared to Avastin Study (LUCAS) was aimed at comparing the efficacy and safety of bevacizumab versus ranibizumab when following a treat-and-extend protocol. The patients received monthly injection treatment until inactive disease was achieved. The treatment interval was then increased by two weeks at a time up to a maximum of 12 weeks. In the event of a recurrence, the treatment interval was reduced by two weeks at a time. The study demonstrated equivalent results in vision improvement with bevacizumab and ranibizumab after two years of treatment. Treatment according to a treat-and-extend protocol was safe with good visual results when extending up to 10 weeks, while recurrences at 12-week intervals had a negative impact on the final results on vision.

Medical Research: What should clinicians and patients take away from your report?

Dr. Berg: The off-label medication bevacizumab is equivalent to ranibizumab when treating nAMD according to a treat-and-extend protocol. Eyes with recurrences at 12-week intervals had a worse outcome in vision at two years than eyes with recurrences at shorter treatment intervals. This suggests either a strategy where upon recurrences, the treatment intervals are reduced more radically or limiting the maximum interval to 10 weeks.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Berg: The ideal strategy for a treat-and-extend modality with different treatment intervals needs to be further explored in future prospective randomized trials.


Ophthalmology. 2015 Oct 15. pii: S0161-6420(15)01040-4. doi: 10.1016/j.ophtha.2015.09.018. [Epub ahead of print]

Ranibizumab or Bevacizumab for Neovascular Age-Related Macular Degeneration According to the Lucentis Compared to Avastin Study Treat-and-Extend Protocol: Two-Year Results.

Berg K1, Hadzalic E2, Gjertsen I3, Forsaa V4, Berger LH5, Kinge B6, Henschien H7, Fossen K8, Markovic S9, Pedersen TR10, Sandvik L11, Bragadóttir R12. 

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Karina Birgitta Berg MD (2015). LUCAS: Lucentis Compared to Avastin Treat and Extend Study For Macular Degeneration