Linda Little

October 18, 2005

Oct. 18, 2005 (Chicago) — Pegaptanib (Macugen; Pfizer) may provide better results if used in the early stages of age-related macular degeneration, researchers reported here at the American Academy of Ophthalmology annual meeting.

An exploratory analysis of the VEGF Inhibition Study in Ocular Neovascularization (VISION) trial showed that treatment with 0.3 mg of pegaptanib sodium injection provided better results in patients with early disease than the overall group of patients.

"Patients with age-related macular degeneration need to be treated earlier so there is not significant visual damage," said Christine R. Gonzales, MD, assistant professor of ophthalmology, Jules Stein Eye Institute and David Geffen School of Medicine, University of California at Los Angeles.

"Early diagnosis and a more timely treatment may be important factors to achieve optimal results," she told Medscape.

The retrospective study results showed that a higher percentage of patients in the two early-disease groups (76% and 80%) lost no more than 15 letters of visual acuity compared with those in the overall VISION group (70%).

Between 12% and 20% of the two subgroups of early-disease patients also gained three or more lines of vision compared with 0 to 4% in the control group. In the overall VISION study group, just 6% of patients with all ranges of age-related macular degeneration gained three or more lines of vision.

The analyses identified VISION study participants with early disease and then assessed visual outcomes at week 54. Patients received either 0.3 mg of pegaptanib or sham injections.

The first group with early disease consisted of patients with lesion size less than 2 disc areas, baseline visual acuity more than 54 ETDRS letters, no prior photodynamic therapy or thermal laser photocoagulation, and an absence of scarring.

The second group of participants considered early stage had no classic choroidal neovascularization, an absence of lipid deposits and better visual acuity in one eye with worse visual acuity in the study eye.

In the first group, 76% of treated patients compared with 50% of those receiving sham injections had a loss of no more than three lines on the study eye chart. And 12% of the treated group gained three lines of vision compared with 4% of those receiving sham injections.

In the second early-disease group, 80% of treated patients had a loss of less than three lines compared with 57% in the control group. While 20% of treated patients gained three lines or more of vision, 9% of the controls gained vision.

The group with earlier disease did much better with treatment, said Dr. Gonzales. "Basically the earlier you treat macular degeneration the better the visual benefit. The goal should be to diagnose and treat the disease at an earlier stage."

Leonard Kirsch, MD, from the Eye Institute of West Florida in Largo, concurred in an interview. "This shows that there is evidence that the earlier patients with macular degeneration are treated the better the outcome."

The initial study "took all comers," not only those with earlier disease but also those with worsening disease, he said. "It behooves us as eye doctors to identify patients early in the course of the disease."

AAO 2005 Annual Meeting: Free Paper PA097. Presented Oct. 18, 2005.

Reviewed by Gary D. Vogin, MD