Real-world outcomes of intravitreal antivascular endothelial growth factors for neovascular age-related macular degeneration in Taiwan: A 4-year longitudinal study

Benjamin Chi-Lan Yang, Terry Yu-Hung Chou, San-Ni Chen, Benjamin Chi-Lan Yang, Terry Yu-Hung Chou, San-Ni Chen

Abstract

Purpose: The purpose of the study is to report the long-term efficacy of patients with neovascular age-related macular degeneration (nAMD) treated with antivascular endothelial growth factor (VEGF) in Changhua Christian Hospital in Taiwan.

Materials and methods: Retrospective case series of patients with nAMD who were treated with intravitreal injection (IVI) of anti-VEGF and had a minimum follow-up of 48 months. Every patient was initially treated with three loading doses of either bevacizumab or ranibizumab, followed by a loose treat and extend regimen. Eyes were divided into two groups according to whether aflibercept was later used as a rescue therapy (Group 2) or not (Group 1). Patients underwent best-corrected visual acuity (BCVA) testing, optical coherence tomography, and ophthalmic examination at baseline and all the scheduled follow-up visits.

Results: Seventy eyes in 63 patients were included (mean age 70.54 ± 9.18 years). The mean number of IVIs per year was 5.28 ± 1.36. The mean BCVA in logarithm of the minimal angle of resolution (logMar) improved from 0.89 ± 0.45 to 0.72 ± 0.49 for all patients (P = 0.004). Significant visual improvement was noted in Group 1 (P = 0.01) at 4 years of follow-up, but not in Group 2 (P = 0.16). Patients with initial poor BCVA (LogMar visual acuity >1.0), and older age (>70 years) had significant visual improvement, in contrast to no significant visual changes in patients with younger age and initial better BCVA.

Conclusion: Under a loose treat and extend protocol and rescue therapy of aflibercept, BCVA improvement was maintained for 4 years in patients with nAMD, especially in the older population (Registration Number: NCT03324542).

Keywords: Aflibercept; age-related macular degeneration; bevacizumab; long term efficacy; ranibizumab.

Conflict of interest statement

The authors declare that there are no conflicts of interests of this paper.

Copyright: © 2019 Taiwan J Ophthalmol.

Figures

Figure 1
Figure 1
Distribution of best-corrected visual acuity in logarithm of minimal angle of resolution from baseline to each subsequent yearly time point
Figure 2
Figure 2
Changes of best-corrected visual acuity in logarithm of minimal angle of resolution visual acuity during the 4 years of follow-up

References

    1. Smith W, Assink J, Klein R, Mitchell P, Klaver CC, Klein BE, et al. Risk factors for age-related macular degeneration: Pooled findings from three continents. Ophthalmology. 2001;108:697–704.
    1. Andreoli CM, Miller JW. Anti-vascular endothelial growth factor therapy for ocular neovascular disease. Curr Opin Ophthalmol. 2007;18:502–8.
    1. Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, et al. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med. 2006;355:1419–31.
    1. Ferrara N, Damico L, Shams N, Lowman H, Kim R. Development of ranibizumab, an anti-vascular endothelial growth factor antigen binding fragment, as therapy for neovascular age-related macular degeneration. Retina. 2006;26:859–70.
    1. Avery RL, Pieramici DJ, Rabena MD, Castellarin AA, Nasir MA, Giust MJ. Intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration. Ophthalmology. 2006;113:363–72e5.
    1. Heier JS, Boyer D, Nguyen QD, Marcus D, Roth DB, Yancopoulos G, et al. The 1-year results of CLEAR-IT 2, a phase 2 study of vascular endothelial growth factor trap-eye dosed as-needed after 12-week fixed dosing. Ophthalmology. 2011;118:1098–106.
    1. Heier JS, Brown DM, Chong V, Korobelnik JF, Kaiser PK, Nguyen QD, et al. Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration. Ophthalmology. 2012;119:2537–48.
    1. Stewart MW, Rosenfeld PJ. Predicted biological activity of intravitreal VEGF trap. Br J Ophthalmol. 2008;92:667–8.
    1. Papadopoulos N, Martin J, Ruan Q, Rafique A, Rosconi MP, Shi E, et al. Binding and neutralization of vascular endothelial growth factor (VEGF) and related ligands by VEGF trap, ranibizumab and bevacizumab. Angiogenesis. 2012;15:171–85.
    1. Bakall B, Folk JC, Boldt HC, Sohn EH, Stone EM, Russell SR, et al. Aflibercept therapy for exudative age-related macular degeneration resistant to bevacizumab and ranibizumab. Am J Ophthalmol. 2013;156:15–220.
    1. Boyer DS, Antoszyk AN, Awh CC, Bhisitkul RB, Shapiro H, Acharya NR, et al. Subgroup analysis of the MARINA study of ranibizumab in neovascular age-related macular degeneration. Ophthalmology. 2007;114:246–52.
    1. Peden MC, Suñer IJ, Hammer ME, Grizzard WS. Long-term outcomes in eyes receiving fixed-interval dosing of anti-vascular endothelial growth factor agents for wet age-related macular degeneration. Ophthalmology. 2015;122:803–8.
    1. Tano Y, Ohji M, EXTEND-I Study Group Long-term efficacy and safety of ranibizumab administered pro re nata in Japanese patients with neovascular age-related macular degeneration in the EXTEND-I study. Acta Ophthalmol. 2011;89:208–17.
    1. Lu Y, Huang J, Zhao J, Yu X, Long L, Dai H. Effects of intravitreal ranibizumab injection on Chinese patients with wet age-related macular degeneration: 5-year follow-up results. J Ophthalmol. 2016;2016:6538192.
    1. Gillies MC, Campain A, Barthelmes D, Simpson JM, Arnold JJ, Guymer RH, et al. Long-term outcomes of treatment of neovascular age-related macular degeneration: Data from an observational study. Ophthalmology. 2015;122:1837–45.
    1. Arevalo JF, Lasave AF, Wu L, Acón D, Berrocal MH, Diaz-Llopis M, et al. Intravitreal bevacizumab for choroidal neovascularization in age-related macular degeneration: 5-year results of the Pan-American collaborative retina study group. Retina. 2016;36:859–67.
    1. Rasmussen A, Bloch SB, Fuchs J, Hansen LH, Larsen M, LaCour M, et al. A 4-year longitudinal study of 555 patients treated with ranibizumab for neovascular age-related macular degeneration. Ophthalmology. 2013;120:2630–6.
    1. Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group. Maguire MG, Martin DF, Ying GS, Jaffe GJ, Daniel E, et al. Five-year outcomes with anti-vascular endothelial growth factor treatment of neovascular age-related macular degeneration: The comparison of age-related macular degeneration treatments trials. Ophthalmology. 2016;123:1751–61.
    1. Gupta OP, Shienbaum G, Patel AH, Fecarotta C, Kaiser RS, Regillo CD. A treat and extend regimen using ranibizumab for neovascular age-related macular degeneration clinical and economic impact. Ophthalmology. 2010;117:2134–40.
    1. Kaiser PK, Brown DM, Zhang K, Hudson HL, Holz FG, Shapiro H, et al. Ranibizumab for predominantly classic neovascular age-related macular degeneration: Subgroup analysis of first-year ANCHOR results. Am J Ophthalmol. 2007;144:850–7.
    1. Ying GS, Huang J, Maguire MG, Jaffe GJ, Grunwald JE, Toth C, et al. Baseline predictors for one-year visual outcomes with ranibizumab or bevacizumab for neovascular age-related macular degeneration. Ophthalmology. 2013;120:122–9.
    1. Matsumiya W, Honda S, Otsuka K, Miki A, Nagai T, Imai H, et al. Comparison of the effectiveness and prognostic factors of intravitreal ranibizumab between typical neovascular age-related macular degeneration and polypoidal choroidal vasculopathy over 24 months of follow-up. Ophthalmologica. 2015;234:33–9.
    1. Pedrosa AC, Sousa T, Pinheiro-Costa J, Beato J, Falcão MS, Falcão-Reis F, et al. Treatment of neovascular age-related macular degeneration with anti-vegf agents: Predictive factors of long-term visual outcomes. Ophthalmoloy. 2017;120:122–9.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit