How Many Lucentis Injections?

How many anti-VEGF injections of Avastin or Lucentis are needed to treat wet macular degeneration?  We don’t know.  While there is no question that anti-VEGF injections are the gold-standard for the treatment of ARMD, the exact way in which they are used varies from doctor to doctor.

Standard of Care

The standard of care for macular degeneration changed.  The standard treatment for wet ARMD was Visudyne and before Visudyne, laser treatment.

Since Macugen, the initial anti-VEGF medication, other accepted standards have evolved including Lucentis and Avastin.

In the medical world, these are still “new” treatments and we are still finding our way.  We are always looking to improve our treatments.

FDA Approval

In short, FDA Approval is needed to get a new drug introduced to the market.  To state another way, FDA approval is needed to make it legal for a company, in the United States, to sell a drug.

Once available on the market, however, the way in which the drug is utilized varies from doctor to doctor.

Testing Serves as a Guideline

When a drug is initially sent to the FDA for approval, careful testing (clinical trials) must be completed proving safety and efficacy of the drug.  The drug company must prove that it is safe in humans and that the drug does what the company claims it does.

For example, in the case of Macugen or Lucentis the treatment protocol used in the study (to prove the drug works)  may have required injections every 6 weeks for more than a year.  During these studies, there is strict adherence to the protocol.  Little variation is allowed.  For instance, every six weeks means every six weeks.  If a patient were to receive an injection other than the 6 week interval, that patient may be removed from the study.

It’s Called Practice

When first introduced, everyone (doctors) followed a very similar protocol.  We followed the protocol that was recommended by the manufacturer.  They can only recommend the protocol approved by the FDA.  That protocol is usually the same one that was included in the original study series.

With time, doctors get familiar with the drug and gain experience using the drug.  Real life situations are not as stringent as FDA studies.  We may find that if  Mr. “Macugen” missed an injection, he does okay anyway.  We may find that Ms. Lucentis can’t get an injection in 6 weeks, but can come in at 5 weeks.

Other studies, not necessarily for FDA purposes, emerge from our academic colleagues that change protocols, too.  Perhaps a study is published from Johns Hopkins purporting great results using injections every week.  Guess what, it’ll change how we practice.

Studies of related products also change how we practice.  For instance, the protocols used for studies involving any of the anti-VEGF medications impact the use of the other drugs.

What Does This Mean?  Treatments vary from doctor to doctor.  The better a treatment, the more variation…in my opinion.  The best treatments are inherently really good and do not require strict methods of employment.

Like a good recipe, a good treatment is hard to mess up.

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Comments

  1. Shirey chander says:

    What are the long term effects from avastin injections for five years I get avastin injection . First it was every three month then every two month now for one year it’s been every six weeks . With no differents In my vision

  2. Dear Shirey,

    I am not aware of any long term effects of Avastin over an extended period such as 5 years.

    Regarding the increased frequency of injections…ask your doctor if you are expected to get improved vision, or, are on maintenance treatment.

    Keep us posted.

    Randy

  3. Just had first injection of lucentis and cannot believe the results! Distortion gone, blurriness vastly improved and pain only lasted few hours! From horrible fear of blindness to hope for future!

  4. Dear Maggie,

    Congratulations! I wish you continued success.

    Randy

  5. Hi, Dr Wong, I am 65 y.o. and have been receiving Avastin injections in both eyes for almost 3 years. I live in the northeast where my doc has gotten me up to 10 weeks between injections but doesn’t want to stretch the interval any further at this time; she says sometimes changes can occur that cannot be reversed. For the past 2 yrs, I’ve been wintering in Florida and getting injections there. The doc in FL tries to convince me to stretch the interval to the point where I see vision changes, but I’m afraid to do so and have to argue with him to keep me at my northern doc’s intervals! Feel like I’m caught between rock & hard place! Any advice? Thanks so much.

  6. Dear Mary,

    Actually, I practice more like your doc in FL. After a period where you have become stable, many retinal specialists choose to have periodic visits and reinject if needed and no longer regularly.

    r

  7. Hi, Thanks for the information all contributors. I would like to print up a ‘good ‘ copy of this Blog so I can read it to my mother, (85 years old) who is currrently being treated for ARMD – - Could you please add a “PRINT” button to this page? Thanks again! – - Debora

  8. Dear Debora,

    Definitely will look into it! For now, I believe most browsers allow you to print.

    Please keep after me!

    Randy

  9. Have you ever heard of loosing vision or getting ARMD – Wet Type after a root canal / endodonic procedure???? The root canal was on the upper rt in the back and the vision loss was in the rt. eye. The dentist also gave several blind shots during the procedure.
    Please give your opinion on this topic.
    Thank you.

  10. Dear Sarah,

    No, I have not.

    I think it would be almost impossible for the eye to be affected from some dental injections.

    Randy

  11. Hello doctor,eight month ago oct 2012,I had RVO in my left eye,I requested to have Lucentis,since Avastin
    Not approved by FDA, I had the injection in two different places,but honestly I discovered I might been giving
    Avastin,due to the prices and profits,they charge you lucentis,and they inject you Avastin,unfortunately,now
    How do I know for sure the different if I have been injected with either one,and my most concern,what will happen
    Or an effect if I have been with both,like once lucentis then after four weaks Avastin then month later lucentis then lucentis then Avastin etc…..,I had so far seven injection within 8 month,the fluid comes and go comes and go etc…
    Please your advise,and my best regards.

  12. Dear Ziad,

    I would like to believe that you are given Lucentis if that is what’s prescribed and requested.

    Regardless, if you had a CRVO, the results are not as favorable as if you had an BRVO…this is true of both Lucentis and Avastin.

    Randy

    Randall V. Wong, M.D.
    Retina Specialist
    Fairfax, Virginia
    http://www.RetinaEyeDoctor.com

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