The National Eye Institute’s CATT (Comparison of Age-related Macular Degeneration Treatments Trial) study was a 2-year study that compared the relative safety and effectiveness of Lucentis (ranibizumab injection) and Avastin (bevacizumab) in the treatment of wet AMD. The “Five-Year Outcomes with Anti-VEGF Treatment of Neovascular AMD” was a follow-up assessment 3 years after patients were released from the 2-year CAT Trial. It evaluated the visual acuity and anatomical outcomes of 647 patients from the original cohort, approximately 5 years after initiation of treatment with either Lucentis or Avastin.
The data shows approximately 50 percent (n=321/647) of patients retained a visual acuity of 20/40 or better after 5 years. However, 60 percent of patients in the follow-up assessment were no longer being treated with their originally assigned therapy and dosing regimen.
The authors concluded, “because very few patients continued to receive the originally assigned drug or dosing schedule between the end of year two and follow-up at approximately five years, the CATT Follow-up Study results provide information primarily on overall treatment outcomes with anti-VEGF drugs and limited information on effects of different drugs and dosing regimens.”
During the 2-year controlled CATT study, the proportions of patients with arteriothrombotic events (ATEs) were balanced, with 4.7 percent of patients treated with Lucentis and 5.0 percent of patients treated with Avastin experiencing an event. In the 5-year assessment, the rates of ATEs were 7.6 percent in patients originally treated with Lucentis and 4.5 percent in patients originally treated with Avastin.
The authors caution, “With most patients changing drugs over time, the ability to identify differential safety effects of the two drugs is compromised. Because of the absence of any difference when the history of drug exposure was certain, we do not believe that the difference in events observed when a large portion of patients were not receiving ranibizumab are meaningful.”
In a statement, Genentech, the maker of both Lucentis and Avastin, stated "Avastin is not approved for use in the eye by the FDA and we do not support or promote unapproved use of our medicines. Decisions about treatment should be made between the physician and patient. We support their right to choose an appropriate medicine. Based on the totality of evidence in support of its efficacy and well-characterized safety profile as well as the depth and breadth of clinical experience in treating complex retinal diseases, Lucentis continues to be an important treatment choice for physicians and patients. We continue to study Lucentis, as well as develop new medicines, to help people with serious eye diseases."
The full CATT follow-up study results can be found in the May 2, 2016 publication of Ophthalmology (Maguire, Maureen G. et al. “Five-Year Outcomes with Anti–Vascular Endothelial Growth Factor Treatment of Neovascular Age-Related Macular Degeneration.” Ophthalmology, May 2, 2016).