Real-World Analysis Supports More Frequent Anti-VEGF Dosing for First-Year nAMD

A retrospective analysis of electronic medical record (EMR) data from newly-diagnosed patients with neovascular age-related macular degeneration (nAMD) found that more injections of anti-vascular endothelial growth factor (anti-VEGF) therapy correlates with greater average visual gains in the first year of treatment, versus fewer injections.

The data, coming from real-world clinical settings, adds a new dynamic to rhetoric surrounding efficient anti-VEGF loading dose and regimen frequency in patients with nAMD.

Study author Andrew A. Moshfeghi, MD, MBA, associate professor and director of the Clinical Trials Unit & Retina Fellowship at USC Roski Eye Institute, Keck School of Medicine, told MD Magazine® the team focused on better understanding the impact of different dosing frequencies.

“Overall, we saw visual acuity trends that favored more frequent dosing to less frequent dosing,” Moshfeghi said following his presentation at the American Society of Retina Specialists (ASRS) Annual Meeting in Vancouver, BC.

Moshfeghi and colleagues analyzed EMR data from patients treated at multiple clinical sites, logged in the Vestrum Health Retina Research Dataset in Naperville, IL. Observed patients were newly diagnosed with nAMD and had been initiated on intravitreal anti-VEGF agents at least 1 year prior to analysis.

Researchers evaluated for patient visual acuity (VA) in 2 dosing subgroups: up to 6 injections, and 7 or more injections, both through 1 year of treatment. Of the 8127 patients with AMD evaluated for the study, 1840 (23.0%) patients received ≤6 injections, and 6287 (77.0%) received ≥7 injections. Measurements for VA were converted into an approximate letter score under the Early Treatment Diabetic Retinopathy Study (ETDRS).

At baseline, patients administered ≤6 injections reported mean VA of 61 letters, while patients administered ≥7 injections reported mean VA of 66 letters. In the former group, 23% of patients presented with baseline VA of ≥20/40; 39% with VA of <20/40 - 20/100, 13% with VA of 20/100-20/200, and 24% with VA of <20/200.

In the patient subgroup of ≥7 injections, baseline VA rates for the corresponding proportions were 21%, 49%, 15%, and 15%, respectively.

Mean injections in patients receiving ≤6 injections were 4.5, and 9.1 in patients receiving ≥7 injections. The former group reported a mean VA gain of 2.1 letters, while the latter group reported a mean VA gain of 6.4 letters.

Moshfeghi said the details of the study—from the 80%/20% split in patients receiving ≥7 injections and ≤6 injections, respectively, to the findings indicating more frequent injections are associated with improved VA&mdash;were consistent with the team’s real-world analysis of patients treated from 2012-2015.

“So, contrary to popular opinion, where we’ve been told over and over again that we’re under-dosing our patients and that our patients are not keeping their appointments appropriately…80% or so of patients were receiving 7 injections or more in their first year, which is admirable,” Moshfeghi said.

Moshfeghi also gave note to the fact that patients more frequently injected anti-VEGF also had higher baseline VA scores—meaning it was already difficult for the patient subgroup to improve its scores more than the less frequently treat subgroup.

The study, "Outcomes of Antivascular Endothelial Growth Factor (VEGF) Therapy for Neovascular Age-Related Macular Degeneration in Routine Clinical Practice," was presented at ASRS 2018 on Saturday.

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