Clinical Studies:

IVAN Study

Summarized by Prethy Rao, MD MPH (Retina and Vitreous of Texas)

Citation: Chakravarthy U, Harding SP, Rogers CA, et al. Ranibizumab versus Bevacizumab to Treat Ranibizumab versus Bevacizumab to Treat Neovascular Age-related Macular Degeneration: One Year Findings from the IVAN Randomized Trial. Ophthalmology, Vol. 119, Issue 7, p1399–1411

  • Objective

    To compare the efficacy and safety of ranibizumab versus bevacizumab (monthly or as-needed treatment regimens) in the treatment of neovascular age-related macular degeneration


    Multicenter, factorial, noninferiority, randomized, treatment-controlled trial (UK-based study)



Randomized 1:1:1 to

(a) Ranibizumab (0.5 mg) monthly

(b) Ranibizumab (0.5 mg) as-needed

(c) Bevacizumab (1.25 mg) monthly

(d) Bevacizumab (1.25 mg) as-needed

All participants attended monthly visits with clinical examination, optical coherence tomography (OCT), and funds photography. All patients were treated at visits 0, 1, and 2. The continuous arm was treated monthly thereafter. The as-needed group were not treated unless they met pre-specified clinical and OCT criteria for active disease. If re-treatment was-needed, then a cycle of 3 monthly doses were required. Subjects and assessment teams were masked; treatment teams were unmasked (14 out of 23 sites).

Amendment later allowed for PDT for any subtype of CNVM if lesion > 4 DA and accompanied by loss of 20 letters of vision.

Re-Treatment Criteria:

OCT Findings: presence of sub retinal fluid, increasing intraretinal fluid, fresh hemorrhage

VA Findings: A visual acuity drop in > 10 letters if OCT parameters were equivocal

FA Findings: >25% fluorescein leakage of the lesion size or expansion of the CNV lesion if VA or OCT did not qualify


Secondary Endpoints

RESULTS (12 months)

Study population

PRIMARY OUTCOME: Distance BCVA at 1 year


Adverse events