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Visual benefits of anti-VEGF therapy may diminish upon extended dosing

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John T. Thompson

BOSTON — Long-term outcomes of anti-VEGF therapy for neovascular age-related macular degeneration suggest that eyes with good visual acuities require long-term regular dosing, according to a presentation here.

"Continued aggressive treatment with anti-VEGF drugs helps to prevent recurrences [of choroidal neovascularization] associated with visual loss. ... Extended therapy and less frequent office visits should be used with great caution in eyes with good visual acuities," John T. Thompson, MD, said at the American Society of Retina Specialists meeting.

A retrospective case series evaluated 182 consecutive eyes treated with Avastin (bevacizumab, Genentech), Lucentis (ranibizumab, Genentech) or both for subfoveal choroidal neovascularization. Eyes were treated every 4 to 6 weeks for the first year, followed by extended dosing — at least every 2 months — or return to more frequent dosing upon regression.

Mean visual acuity significantly improved for all eyes during the first 2 years. Eyes that achieved 20/100 or better generally maintained improvements up to 4 years. Unlike previous outcomes of studies assessing thermal laser, photodynamic therapy or Macugen (pegaptanib sodium, Eyetech/Pfizer), mean visual acuity improved from baseline for many patients even after 4 years, Dr. Thompson said.

Recurrent activity of choroidal neovascularization was the most common reason for visual acuity loss during extended dosing and recovered in only one-third of eyes, he said. Visual loss of three or more Snellen lines was reported 56% of the time during extended dosing.

• Disclosure: Dr. Thompson has no relevant financial disclosures pertaining to this study. However, he has received grant support from Genentech.