Off-label use of intravitreal bevacizumab for severe retinopathy of prematurity

Resumen Objetivo Examinar la calidad de la evidencia y variabilidad en el uso off-label de bevacizumab intravitreo en retinopatia del prematuro (ROP). Metodos Se realizo una revision amplia en Pubmed, Cochrane, Medline, utilizando las palabras factor de crecimiento vascular endotelial (VEGF), retinopatia del prematuro, tratamiento y bevacizumab. Resultados Se encontraron publicados casos y series de casos, revisiones, una revision sistematica y un ensayo clinico controlado y aleatorizado sobre uso de bevacizumab intravitreo en ROP severa, como monoterapia o combinado con laser o vitrectomia. Conclusiones Aunque los resultados de la revision han mostrado que la inyeccion intravitrea de bevacizumab es promisoria para el tratamiento de la ROP estadio 3+ en zona I o la ROP agresiva posterior, aun permanecen inciertas algunas cuestiones fundamentales como dosis maxima aceptada para prematuros, riesgo de efectos colaterales sistemicos y oculares a largo plazo, eficacia y bioactividad en un nino en desarrollo. En los reportes no hubo diferencias significativas en la tasa de recurrencia entre el tratamiento con bevacizumab intravitreo como monoterapia y tratamiento laser para el estadio 3 en zona II ; este ultimo es la mejor opcion por seguridad y efectividad a largo plazo. En los estadios 1 y 2 de ROP no esta indicado el tratamiento con bevacizumab intravitreo porque el riesgo de perdida visual severa es bajo y el VEFG es necesario para el desarrollo de los vasos normales de la retina. Por otra parte, en estadios 4 y 5 deberia ser contraindicado el uso de bevacizumab intravitreo porque acelera el desprendimiento de retina traccional.

Uso off-label de bevacizumab intravítreo en retinopatía del prematuro severa

BackgroundScotland’s ‘A’ Research Ethics Committee (SAREC, previously MREC A) has exclusive authority to consider research involving Adults with Incapacity in Scotland. No appeal facility exists although resubmissions are accepted. Legislation covering research in England and Wales has created anomalies. RECs ‘recognised’ by the UK Ethics Committee (3 in Scotland, several in England) can approve drug studies involving Adults with Incapacity in Scotland. Several English RECs can approve studies led from outside Scotland.MethodsWe conducted an anonymous online survey of researchers experienced in studies involving Adults with Incapacity to establish their opinions on the role of SAREC. The survey had 5 multiple-choice questions. Two questions invited a free-text comment.ResultsSeventy-seven researchers (45% response) completed the survey. The majority (61/76, 80%) received a favourable opinion from SAREC immediately/after minor revision. The consensus was a single, experienced committee is advantageous to r...

A survey of principal researchers who lead research into Adults with Incapacity in Scotland.

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A survey of principal researchers who lead research into Adults with Incapacity in Scotland.