Different Treatment Approach Needed for NAMD

Vincent Garmo, MHS

Findings of a new network meta-analysis suggested that different regimens evaluated for neovascular age-related macular degeneration (nAMD) did not result in superior vision benefits compared with ranibizumab, pro re nata, or four-week dosing.

The findings, published on ARVOLearn due to the cancellation of the 2020 Association for Research in Vision and Ophthalmology (ARVO) annual meeting, highlighted that greater visual improvements could require a different approach to treatment.

NAMD is a leading cause of vision loss for individuals >50 years old. Current clinical guidelines recommend intravitreal anti-vascular endothelial growth factor (VEGF) therapy for patients with nAMD. There are several agents and dosing regimens used to manage the condition, such as ranibizumab, aflibercept, brolucizumab, and off-label bevacizumab.

No single study, however, compared all the treatment regimens available, Vincent Garmo, MHS, said during his presentation of the study findings. Garmo, a principal health economist at Genentech, and a team of investigators conducted a systematic literature review to identify randomized controlled trials of anti-VEGF therapy for nAMD. The investigators extracted >20 visual, anatomic, and safety results to identify commonly reported outcomes that could be meaningfully compared using network meta-analysis methodology.

As needed and monthly ranibizumab were the most common treatment comparator arms across the included studies. The analysis found that the outcomes that could be compared using network meta-analysis were 3 best-corrected visual acuity (BCVA) outcomes: mean change at baseline at month 12 and month 24 and the proportion of patients gaining >15 ETDRS letters at month 12. All of the studies had similar baseline characteristics.

The team included 21 randomized controlled trials for BCVA change at month 12. Baseline VA varied from 52-65 letter across all trials. Four-week doses of ranibizumab and pro re nata were references cases.

There were 12 studies that evaluated reported mean change in BCVA from baseline to month 24. A network could be formed between 10 of the 13 anti-VEGF treatment regimens for such an outcome.

The investigators found that change in BCVA from baseline at month 24 for monthly ranibizumab was significantly improved over ranibizumab (pro re nata) by 1.7 EDTRS letters, but the finding was not clinically significant, Garmo said.

The analysis found that there were no statistically significant differences in any of the evaluable outcomes in any comparison with ranibizumab four-week doses or pro re nata.

Overall, the analysis suggested that the different regimens evaluated did not result in better vision compared with ranibizumab pro renata or the four-week dose.

“If confirmed, these results suggest that greater visual acuity improvements may require a different approach to treatment, such as different drug delivery paradigm or the development of drugs with different or multiple mechanisms of action,” Garmo.

The study, “Comparative efficacy of anti-vascular endothelial growth factor (VEGF) treatment regimens for neovascular age-related macular degeneration (nAMD): A network meta-analysis,” was published online on ARVOLearn.