High Rates of nAMD Patients Cease Anti-VEGF Treatment Over Time

Robert P. Finger, MD, PhD

Neovascular age-related macular degeneration (nAMD) is the largest single cause of irreversible sever vision loss in high-income countries worldwide. However, while the advent of vascular endothelial growth factor (VEGF) inhibitors have enabled doctors to begin to treat nAMD, there is no data on the lifetime outcomes of this treatment.

A team, led by Robert P. Finger, MD, PhD, Department of Ophthalmology, University of Bonn, determined the visual acuity outcomes of anti-VEGF treatment for nAMD in both eyes for the remaining lifetime of patients.

In the study, the investigators used multistate modeling with real-world cohort data to examine the outcomes of 3192 patients with nAMD involving more than 67,000 visits for treatment at routine eye clinics in Australia, New Zealand, and Switzerland.

The investigators sought main outcomes of visual acuity in both eyes over the remaining lifetime of the patient.

For the mean remaining lifetime of 11 years, an estimated 12% (n = 371; 95% CI, 345-400) of the sample retained driving visual acuity. In addition, an estimated 15% (n = 463; 95% CI, 434-495) had reading visual acuity in at least 1 eye.

At that time, an estimated 82% of the sample (n = 2629; 95% CI, 2590-2660) had dropped.

The investigators also found a younger baseline age and more injections during the first year of treatment was linked to better long-term outcomes.

“Anti-VEGF treatment was associated with preserved useful visual acuity in almost 20% of patients over their average remaining lifetime,” the authors wrote. “More than 80% of patients will cease treatment over that time, having likely experienced a deterioration of vision beforehand. This is a remarkable outcome compared with outcomes without intervention, which lead to legal blindness within 3 years of disease onset in 80% of those affected. These findings underline the public health necessity of providing anti-VEGF treatment to persons in need.”

Recently, investigators found a number of outcomes for patients with nAMD are directly related to the retinal thickness variations following the initiating of anti-VEGF treatment.

When initiating anti-VEGF treatment for patients with nAMD, prognostic factors often guide specific treatments. It is believed that eyes with greater fluctuation in retinal thickness over time have worse outcomes than eyes with less variation.

After the investigators adjusted for baseline BCVA and trial allocations, BCVA worsened significantly across the quartiles of FCPT standard deviation.

Overall, the difference between the first and fourth quartiles was -6.27 Early Treatment Diabetic Retinopathy Study letters (95% CI, -8.45 to -4.09).

They also found the risk of developing fibrosis and macular atrophy increased across FCPT SD quartiles.

The odds ratios ranged from 1.40 (95% CI, 1.03-1.91) for quartile 2 to 1.95 (95% CI, 1.42-2.68) for quartile 4 for fibrosis. The OR also ranged from 1.32 (95% CI, 0.90-1.92) for quartile 2 to 2.10 (95% CI, 1.45-3.05) for quartile 4 for macular atrophy.

The study, “Lifetime Outcomes of Anti–Vascular Endothelial Growth Factor Treatment for Neovascular Age-Related Macular Degeneration,” was published online in JAMA Ophthalmology.