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Baseline characteristics predict visual acuity after anti-VEGF treatment for wet AMD

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LAS VEGAS — Lower baseline best corrected visual acuity, younger age and smaller total choroidal neovascular leakage area were found to predict better visual acuity in patients treated with ranibizumab in a subanalysis of 1-year data from the HARBOR study, a speaker said here.

HARBOR is a phase 3 multicenter study that recruited patients with naïve active subfoveal choroidal neovascularization in the setting of age-related macular degeneration, Brandon Busbee, MD, told colleagues at the American Society of Retina Specialists meeting. Patients were randomized to four Lucentis (ranibizumab, Genentech) treatment groups: 0.5 mg standard dose monthly, 0.5 mg loading dose followed by as-needed treatment, 2 mg monthly, and 2 mg loading dose plus as-needed treatment. The primary endpoint was vision change at 12 months.

 “From this analysis, we explored significant baseline predictors, vision change at month 12, vision gain of 15 letters or greater at month 12, and total number of injections over the 12 months in the PRN arm,” Busbee said.

“If a subject entered this trial with 20/40 vision or worse, the odds were 4.6 times that they would gain three letters of vision during this trial,” he said. If total CNV leakage area was less than 4.51 disc diameters at baseline, odds were 2.5 times for gaining three lines or more of vision.

Size of subretinal fluid thickness at baseline was predictive of the number of injections needed in the as-needed arm of the study, Busbee said.

“Increase in subretinal fluid thickness at baseline required a greater number of injections over the first 12 months,” he said. “For patients who had 118 µm or less of fluid, on average these patients received 7.3 injections, compared to 8.9 injections if you had over 118 µm of subretinal fluid thickness at baseline.” In both groups patients gained approximately eight letters of vision.

“Understanding which baseline characteristics are predictive of visual acuity gains may help clinicians advise their patients with wet AMD,” Busbee said.

• Disclosure: Busbee is a speaker and consultant for and receives research funding from Genentech and Regeneron.