Anti-VEGF therapy benefits in wet AMD not sustained

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By Lucy Piper, Senior medwireNews Reporter

Real-world experience of anti-vascular endothelial growth factor (VEGF) therapy for patients with wet age-related macular degeneration suggests that initial improvements in visual acuity are not maintained over time.

The AURA findings suggest that, in clinical practice, more frequent injections and monitoring may be needed, say researcher Sobha Sivaprasad (King’s College Hospital, London, UK) and colleagues.

The trial involved ranibizumab, intravitreal injections of which have resulted in significant improvements in visual acuity that have been maintained with monthly treatment in clinical trials. However, the researchers comment that this frequency of injections is associated “with significant treatment burden for patients, caregivers and physicians, often making such a regimen unachievable in clinical practice.”

The team evaluated the medical records of 2227 patients who had received at least one anti-VEGF injection, with 1-year follow-up after the first injection available for 1695 patients and at least 2 years of follow-up available for 1184.

Visual acuity improved until about day 120, after which visual gains were not maintained. The average change in visual acuity from baseline was +2.4 letters at 1 year and +0.6 letters at 2 years.

Patients who received their first three injections within 90 days had greater initial improvements in visual acuity than those whose treatment was not delivered in a loading scheme, but it had no effect on the rate of subsequent visual decline.

The researchers note in the British Journal of Ophthalmology that patients visited their ophthalmologists more frequently and received more anti-VEGF injections during the first year than in the second year, at an average of 8.6 versus 4.9 and 5.0 versus 2.2, respectively.

Visual outcomes and injection frequency varied substantially among the countries participating in the study, which included France, Germany, the UK, Italy and the Netherlands, and are likely to be due to the varying “constraints and incentives” within the healthcare systems of those countries, Sivaprasad and team suggest.

They found that the main reason patients discontinued treatment was due to having stable disease, as determined by the treating physician, or treatment failure.

“This highlights the need to ensure that patients continue to be monitored and receive appropriate treatment”, the researchers comment.

They recommend: “Ongoing research into treatment schedules and alternative therapies may help to reduce the trade-off between treatment burden and visual outcomes.”

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