Not All With AMD May Need Continuing Treatment

By David Douglas

February 10, 2020

NEW YORK (Reuters Health) - A small number of patients with neovascular age-related macular degeneration (nAMD) continue to maintain good vision years after cessation of anti-VEGF therapy, according to an analysis of trial results.

However, as Dr. Drew Scoles of the University of Pennsylvania, in Philadelphia, told Reuters Health by email, "Unfortunately, we were not able to predict which patients could successfully stop therapy at the onset of treatment."

In a paper in JAMA Ophthalmology, Dr. Scoles and colleagues note that several studies have identified characteristics before treatment and during follow-up that are associated with poor visual outcome in nAMD patients.

In the current case-control study, the researchers conducted a post hoc analysis of The Comparison of Age-Related Macular Degeneration Treatments Trials (CATT) in which 625 eyes were treated with ranibizumab or bevacizumab. The aim was to determine characteristics that might be associated with higher visual acuity following cessation of treatment.

After two years, the participants in CATT ceased the clinical trial protocol and went on to treatment at the discretion of their ophthalmologists. The CATT follow-up study determined that 90 eyes (14.8%) received no further anti-VEGF treatment. Of these, 40 (6.4%) retained good visual acuity (Snellen 20/40 or better) at five years.

Mean visual acuity letter score at five years was 79.0 in the group with good visual acuity (GVA) compared to 57.5 in the other group of 585 eyes. Those in the GVA group were also significantly younger, with a mean age of 74.7 years compared to 77.7 years, and more (65.0%) were women.

Baseline characteristics were similar between groups, but the GVA group had a better visual acuity letter score in the study eye and in the fellow eye. Blocked fluorescence was also significantly more common in the GVA group.

During the two initial years of the study those in the GVA receiving as-needed treatment also had a lower mean number of injections than their counterparts in the other group.

"Unique characteristics of eyes that could discontinue treatment while maintaining good visual acuity could not be identified at baseline, but data suggest that not all eyes with this disease may need treatment forever," the researchers conclude.

The study did not have commercial funding. One of Dr. Scoles' coauthors report ties to Genentech, which sells both ranibizumab and bevacizumab.

SOURCE: https://bit.ly/2OxAP7Y JAMA Ophthalmology, online January 30, 2010.

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