The CATT study: Avastin and Lucentis equally effective for macular degeneration [Classics Series]

Classics Series, Landmark Trials in Medicine

1. Lucentis (ranibizumab) and Avastin (bevaciumab) demonstrated equivalent effects on visual acuity in age-related macular degeneration (AMD) patients after 1 year of treatment.

2. There was no difference in final visual acuity between injections completed as needed based on exam findings and injections completed on a monthly schedule.

Original Date of Publication: May 2011

Study Rundown: Both ranibizumab (Lucentis) and bevacizumab (Avastin) are anti-VEGF medications used to treat AMD. However, only Lucentis has been FDA-approved for treatment of AMD. The purpose of the Comparison of Age-related Macular Degeneration Treatment Trials (CATT) study was to evaluate the efficacy of both treatment options. The trial recruited over 1200 patients with neovascular AMD across multiple centers in the United States; recruited patients were randomized to Lucentis or Avastin injections and to either monthly injections or as needed injections based on monthly clinical exams. The primary outcome of interest was change in visual acuity in 1 year.

At the conclusion of the trial, the study demonstrated no significant difference in visual acuity changes between the groups randomized to Lucentis or Avastin. Furthermore, there was no significant difference in visual acuity between monthly versus as-needed injections for either medications. Rates of major complications were similar in both groups, although hospitalizations were more common with Avastin treatment. The study demonstrated non-inferiority of Avastin compared to Lucentis in the treatment of AMD, although it suggested an increase in adverse effects with Avastin. The study also supported the use of these medications on an as need basis rather than monthly injections.

Click to read the study in NEJM

In-Depth [randomized controlled trial]: This study was a multicenter, single-blind, non-inferiority trial comparing Avastin and Lucentis for patients with AMD. Overall, 1208 participants were recruited and divided into 4 groups: Lucentis monthly, Avastin monthly, Lucentis when neovascularization present (when needed), and Avastin when neovascularization present (when needed). Patients were monitored every 4 weeks with visual acuity assessment and retinal thickness measurement by optical coherence tomography. Following 1 year of follow-up, patients treated with Lucentis and Avastin-monthly gained 8.5 and 8.0 letters on the visual chart, respectively (p=0.16). Patients treated with Lucentis and Avastin as needed gained 6.8 and 5.9 letters, respectively. Lucentis-monthly patients had significantly decreased retinal thickness compared to the Avastin or Lucentis-as needed groups (mean decrease of 196 um; p=0.03). Adverse reactions were notably higher in the Avastin group compared to Lucentis (24.1% vs. 19.0% respectively; p=0.04). However, the risk of death, myocardial infarcation, and stroke at 1 year were similar for both medications (p>0.20).

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Image: PD

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