Impact of the Nationwide Avastin Ban at a Tertiary Eye Care Hospital in Pakistan.

ABSTRACT

OBJECTIVE:  To report the impact of a 10-week-long nationwide ban on intra-vitreal bevacizumab (IVB) injection (Avastin®) at a tertiary care hospital in Pakistan. METHODS: This was a single-center, retrospective, cohort study. Patients scheduled for IVB injections from October 25, 2023 to October 29, 2023 who arrived in OPD between November 28, 2023 and December 15, 2023 for their assessment were included in this study. RESULTS: Among the identified 412 patients, only 103 met the inclusion criteria. The mean age was 59.35 ± 9.5 (mean ± SD). About 60.2% were male (n = 62). Diabetic macular edema (DME) was the most common indication (n = 71, 68.9%). The mean total duration of treatment delay was 81.67 ± 17.15 days. While the delay due to the Avastin® ban was 67.47 ± 4.8 days. Eyes that had not received any prior injections were 46 (44.7%) while others had received at least 1 (n = 43, 41.7%) or 2 injections (n = 14, 13.6%) before. Mean central macular thickness (CMT) before and after treatment delay was 362.7 ± 113.4 µm and 398.38 ± 124 µm (p < 0.05), respectively. Among 20 patients with vitreous hemorrhage (VH), 14 patients showed marked improvement (70%), 5 showed no change in severity (20%) and 1 (5%) had further worsening. CMT difference was strongly correlated with the total duration of treatment delay (p < 0.01) and with the number of injections (p < 0.01). CONCLUSION: The nationwide ban on Avastin® heightened the severity of disease in the patients highlighting the delicate balance between safety precautions and timely access to essential medical interventions.