Treat-and-extend may lead to better AMD results
Treating neovascular age-related macular degeneration (nAMD) patients with anti-vascular endothelial growth factor (anti-VEGF) ranibizumab (Lucentis, Genentech) on a monthly regimen has produced “great results” in clinical trials, said Prof. Mark C. Gillies, MBBS, PhD. “But what happens after that and what happens in real world practice?”
Dr. Gillies pointed out that early results have not been promising, with almost all eyes developing macular atrophy, and losing vision compared to baseline over the long term. He said that starting treatment earlier is better, adding to the growing literature on the topic.
“We know that atrophy is natural part of the disease,” said Dr. Gillies of the University of Sydney, Australia. “All patients will get it if they live long enough, but we also know from the Comparison of AMD Treatment Trial (CATT) and The UK Inhibition of VEGF in Age-related choroidal Neovascularization (IVAN) studies that the eyes that were treated frequently in these studies had a greater incidence of development of new macular atrophy.”
The Fight Retinal Blindness! (FRB) database identified 1,212 eyes of 1,048 patients who were treatment-naïve when they started 5 years previously and were treated in Australia, New Zealand, and Switzerland, predominantly with ranibizumab, but a few were treated with bevacizumab. By year 5, data was available on 549 eyes, and by year 7, data was available on 131 eyes.
The shorter long-term outcomes were positive, with the mean visual acuity gain after 5 years at 0.7 ETDRS letters, with 43% of the eyes having a visual acuity of at least 70 letters or better. However, vision did wane with time, mimicking the decline in effect from other long-term studies.
After 7 years, the FRB cohort had lost 2.8 letters, which compares favorably to the SEVEN-UP extension study which reported an overall 8.6-letter decline over an average 7.3 years of follow-up. In the CATT analysis, the overall loss of letters at 5 years was 3.3, Dr. Gillies said.
“We also found that the eyes that started with good vision didn’t improve but they retained good vision,” Dr. Gillies said. “Whereas eyes that had poor vision at baseline (35 letters or worse) had good improvements but they still couldn't see very well.”