Avastin®
GoodRxBevacizumab · injectable solution
Injections & Implants
OFF-LABELNot in the FDA label for this product
Neovascular (wet) age-related macular degeneration
1.25 mg in 0.05 mL by intravitreal injection, typically monthly or as needed on OCT and acuity review
RCT, n=1185
The CATT trial randomised patients with neovascular AMD to bevacizumab or ranibizumab, monthly or as-needed. At two years bevacizumab and ranibizumab produced equivalent effects on visual acuity when given on the same schedule, and as-needed dosing produced less gain than monthly dosing for both drugs.
Diabetic macular edema and macular edema following retinal vein occlusion
1.25 mg in 0.05 mL by intravitreal injection, repeated on OCT and acuity review
RCT, n=660
Protocol T compared aflibercept, bevacizumab and ranibizumab for centre-involved diabetic macular oedema. At one year all three improved vision; aflibercept was more effective than bevacizumab where baseline acuity was 20/50 or worse, and the three were comparable where baseline acuity was better than that.
Contraindications
None.
Available FormsInjection, supplied for intravenous oncology use as 100 mg/4 mL and 400 mg/16 mL single-dose vials. Ophthalmic use requires compounding into single-use syringes by a compounding pharmacy.
Mechanism of ActionBevacizumab binds VEGF and prevents the interaction of VEGF to its receptors Flt-1 and KDR on the surface of endothelial cells. The interaction of VEGF with its receptors leads to endothelial cell proliferation and new blood vessel formation.
Warnings & Precautions
- Compounding: the ophthalmic product does not come from the manufacturer. Clusters of endophthalmitis have been traced to compounding failures, so the pharmacy matters as much as the technique.
- Intravitreal injection carries a risk of endophthalmitis, retinal detachment and raised intraocular pressure.
- The intravenous label carries boxed-level warnings for gastrointestinal perforation, wound healing complications and severe haemorrhage; these belong to systemic dosing, which is orders of magnitude above the intravitreal dose.
- Arterial thromboembolic events have been reported after intravitreal VEGF inhibition, though causality is unsettled.
Common Side Effects
Ocular, after intravitreal injection: conjunctival haemorrhage, eye pain, floaters and raised intraocular pressure, with endophthalmitis and retinal detachment as rare but serious events. Systemic, from the oncologic intravenous use: hypertension, proteinuria, epistaxis, headache and impaired wound healing.
Pregnancy & LactationPregnancy: Avastin may cause fetal harm in pregnant women. Limited postmarketing reports describe cases of fetal malformations with use of Avastin in pregnancy.
Pediatric UseSafety and effectiveness in pediatric patients have not been established. Intravitreal bevacizumab has been used off-label in retinopathy of prematurity, where systemic VEGF suppression and its effect on developing organs remain a subject of study.