A randomised controlled trial of alternative treatments toInhibit VEGF in Age-related choroidal Neovascularisation (IVAN)
Wet or neovascular age-related macular degeneration (nAMD) is a condition which causes severe sight loss in older people. This condition is due to a pathological process in which new blood vessels grow into the central region of the retina of the eye, known as choroidal neovascularisation (CNV). These vessels are leaky and lead to the accumulation of fluid between and within the layers of the retina with serious adverse effects on central vision.
Lucentis® is an ‘anti-VEGF’ drug which is injected monthly into the eye which causes these blood vessels to stop leaking and to shrink. With treatment, eyesight improves in a quarter of affected people and, in the majority (90% or more), eyesight does not deteriorate over two years. These results represent a major improvement over previous treatments. Another anti-VEGF drug, Avastin® (from which Lucentis was derived), may be equally good and is considerably less expensive but its efficacy and safety have only been studied in case series.
The IVAN trial wass a head-to-head comparison of the efficacy and safety of Avastin® and Lucentis®. The IVAN trial studied whether the number of treatments needed can be reduced by comparing monthly anti-VEGF treatment for 2 years with monthly anti-VEGF treatment for 3 months only, with careful monthly review and re-starting treatment if any signs of disease recur.
The study randomised patients to various combinations of active treatment; all patients recruited to the trial received anti-VEGF treatment in one or other combination. Eyesight was assessed at each visit and information collected on quality of life and the costs and burden of illness, which was compared between the different groups after 1 and 2 years follow-up.
Two Year Findings
Tthe two-year findings of the IVAN trial, led by Professor Usha Chakravarthy (Queens University) and co-ordinated by Bristol CTEU, were presented in a planetary session at the Association for Research in Vision and Ophthalmology (ARVO) conference in May 2013. The results show that the two drug treatments Lucentis and Avastin are equally effective in treating neovascular or wet age-related macular degeneration (wet AMD).