Age Influences Anti-VEGF Effectiveness in DME Treatment

Credit: Danie Franco/Unsplash

Older patients with diabetic macular edema (DME) experienced poorer response to anti-vascular endothelial growth factor (VEGF) treatment, according to analysis of multiple trials from the DRCR Retina Network.¹

These data, presented at the American Society of Retina Specialists (ASRS) 42nd Annual Meeting, showed older eyes with DME experienced a suboptimal response in visual acuity (VA) and central subfield thickness (CST) after treatment with 3 anti-VEGF agents compared with younger patients.

“We found that the older the patient, the smaller the increase in VA and the smaller the decrease in CST,” said Maureen Maguire, PhD, DRCR Retina Network.² “This finding was consistent when using other definitions of suboptimal treatment response for all 3 anti-VEGF agents, for all 3 trials, and after adjustment for baseline differences in age groups.”

A previous post hoc analysis of a DRCR Retina Network randomized trial found older age was correlated with a higher risk for meeting criteria for switching anti-VEGF agents due to suboptimal response.¹

Within this exploratory analysis, Maguire and colleagues assessed data across the DRCR Retina Network to investigate the link between age and response in VA and CST after anti-VEGF treatment.

The analysis combined eyes with DME assigned to aflibercept, bevacizumab, or ranibizumab in 3 randomized clinical trials: Protocols I, T, and AC. Baseline age was categorized as <50, 50–59, 60–69, and ≥70 years.

Regression and Cox proportional hazards models were used to evaluate the connection between age with change in VA or CST and suboptimal treatment response, respectively. These models were adjusted for potential confounders, including diabetes duration, HbA1c, VA, CST, sex, race or ethnicity, diabetes type, DME status in the fellow eye, proliferative diabetic retinopathy, prior DME treatment, and lens status.

Baseline characteristics showed 119 patients were aged <50, 306 were aged 50–59, 387 were aged 60–69, and 194 were aged ≥70. This youngest age group (<50) had a lower percentage of White (49%), female (29%), and type 2 diabetes (78%), as well as a shorter duration of diabetes (14 years) and higher median HbA1c (8.4).

At the 2-year mark, the adjusted mean VA increase from baseline decreased with older age, from +17.9 in the youngest cohort to +9.0 in the oldest (P <.001). The adjusted mean CST reductions also decreased with older age, from –183 in the youngest cohort to –158 in the oldest (P = .02).

Notably, Maguire and colleagues found these trends present for all anti-VEGF agents, including aflibercept, bevacizumab, and ranibizumab. Analyses were then performed to determine the 2-year adjusted proportion of patients with suboptimal response to these anti-VEGF agents.

These data showed suboptimal VA response increased with older age, from 60% (95% CI, 50–69) in the youngest cohort to 84% (95% CI, 78–89) in the oldest (P <.001). Suboptimal CST response also increased with older age, from 42% (95% CI, 34–52) in the youngest cohort to 62% (95% CI, 54–70) in the oldest (P = .009).

Once more, Maguire and colleagues found these trends apparent for all 3 anti-VEGF agents, without an agent-to-age interaction.

“These results may be helpful to refine expectations regarding treatment outcomes when initiating therapy for DME with anti-VEGF drugs,” Maguire added.

Reference

1. _{Mansour H. Atrophy Growth Rates in Neovascular Age-Related Macular Degeneration Compared to Fellow Eyes With Dry Age-Related Macular Degeneration. Poster presented at the American Society of Retina Specialists (ASRS) 42nd Annual Meeting. Stockholm, Sweden. July 17-20, 2024.}
2. _{The American Society of Retina Specialists. 2024 Top 10 Poster Award Winners. The American Society of Retina Specialists. Accessed July 29, 2024. https://www.asrs.org/clinical/clinical-and-surgical-videos/updates-from-the-field-video-interviews-with-experts-at-key-retina-meetings/2024-top-10-poster-award-winners.}