Macular neovascularization lesion type and vision outcomes in neovascular age-related macular degeneration: post hoc analysis of HARBOR

K Bailey Freund, Giovanni Staurenghi, Jesse J Jung, Sandrine A Zweifel, Mariano Cozzi, Lauren Hill, Steven Blotner, Min Tsuboi, Shamika Gune, K Bailey Freund, Giovanni Staurenghi, Jesse J Jung, Sandrine A Zweifel, Mariano Cozzi, Lauren Hill, Steven Blotner, Min Tsuboi, Shamika Gune

Abstract

Purpose: To characterize relationships between Consensus on Neovascular Age-Related Macular Degeneration Nomenclature (CONAN) Study Group classifications of macular neovascularization (MNV) and visual responses to ranibizumab in patients with neovascular age-related macular degeneration (nAMD).

Methods: This was a post hoc analysis of the phase 3 HARBOR trial of ranibizumab in nAMD. Analyses included ranibizumab-treated eyes with baseline multimodal imaging data; baseline MNV; subretinal and/or intraretinal fluid at screening, baseline, or week 1; and spectral-domain optical coherence tomography images through month 24 (n = 700). Mean best-corrected visual acuity (BCVA) over time and mean BCVA change at months 12 and 24 were compared between eyes with type 1, type 2/mixed type 1 and 2 (type 2/M), and any type 3 MNV at baseline.

Results: At baseline, 263 (37.6%), 287 (41.0%), and 150 (21.4%) eyes had type 1, type 2/M, and any type 3 lesions, respectively. Type 1 eyes had the best mean BCVA at baseline (59.0 [95% CI: 57.7-60.3] letters) and month 24 (67.7 [65.8-69.6] letters), whereas type 2/M eyes had the worst (50.0 [48.6-51.4] letters and 60.8 [58.7-62.9] letters, respectively). Mean BCVA gains at month 24 were most pronounced for type 2/M eyes (10.8 [8.9-12.7] letters) and similar for type 1 (8.7 [6.9-10.5] letters) and any type 3 eyes (8.3 [6.3-10.3] letters).

Conclusion: Differences in BCVA outcomes between CONAN lesion type subgroups support the use of an anatomic classification system to characterize MNV and prognosticate visual responses to anti-vascular endothelial growth factor therapy for nAMD.

Trial registration: ClinicalTrials.gov identifier: NCT00891735. Date of registration: April 29, 2009.

Keywords: Consensus on Neovascular Age-Related Macular Degeneration Nomenclature (CONAN); Macular neovascularization; Neovascular age-related macular degeneration; Ranibizumab; Visual acuity.

Conflict of interest statement

KBF has served as a consultant to Allergan, Bayer HealthCare, Carl Zeiss Meditec, Genentech, Inc., Heidelberg Engineering, Novartis, and Regeneron, and has received grant support from Genentech, Inc. and Roche. GS has served as a consultant to Allergan, Apellis, Bayer HealthCare, Boehringer Ingelheim, CenterVue, Chengdu Kanghong, Genentech, Inc., Heidelberg Engineering, Novartis, and Roche; received grant support from Carl Zeiss Meditec, CenterVue, Heidelberg Engineering, Nidek, Optos, Optovue, Quantel Medical, and Topcon; received lecture fees from Bayer HealthCare, Heidelberg Engineering, Nidek, Novartis, and Roche; and declares patents and/or royalties from Ocular Instruments. JJJ has served as a consultant to Carl Zeiss Meditec. SZ has served as a consultant to Allergan, Bayer HealthCare, Novartis, and Roche, and received grant support from Bayer HealthCare and Novartis. MC has received grant support from Bayer HealthCare, CenterVue, and Nidek. LH has served as a consultant to Aerpio, Alimera, Genentech, Inc., PolyPhotonix, and RecensMedical. SB and SG are employees of Genentech, Inc. MT was an employee of Genentech, Inc. during the course of this study (current employee of Kodiak Sciences Inc.).

© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Figures

Fig. 1
Fig. 1
Mean BCVA over 24 months by baseline MNV lesion type in a, pooled monthly and PRN treatment arms; b, monthly treated eyes; and c, PRN-treated eyes in HARBOR. Error bars represent 95% CI. BCVA best-corrected visual acuity, ETDRS Early Treatment Diabetic Retinopathy Study, MNV macular neovascularization, PRN pro re nata (as-needed), type 2/M type 2/mixed type 1 and 2
Fig. 2
Fig. 2
Mean BCVA change by baseline MNV lesion type in: a, pooled monthly and PRN treatment arms; b, monthly treated eyes; and c, PRN-treated eyes in HARBOR. Error bars represent 95% CI. BCVA best-corrected visual acuity, ETDRS Early Treatment Diabetic Retinopathy Study, MNV macular neovascularization, PRN pro re nata (as-needed), type 2/M type 2/mixed type 1 and 2

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