This article is more than 5 years old. Information may no longer be current.
Retinal atrophy raises concern about long-term anti-VEGF treatment, overdosing
Click Here to Manage Email Alerts
LONDON – Anti-VEGF currently remains the best option for preserving vision in AMD patients, but might as a side effect, accelerate atrophy, according to one specialist.
Long-term results of anti-VEGF therapy in various countries show stabilization of vision and positive response in most patients, with an overall 50% reduction of AMD-related legal blindness since the introduction of anti-VEGFs.
Frank Holz
“However, a proportion of patients are not responding favorably. Undertreatment has been shown to be an issue in real-life clinical practice, but overdosing and atrophy may also play a role,” Frank Holz, MD, said at the EuRetina Congress.
Atrophy, he noted, is part of the natural progression of AMD, but it may be triggered or accelerated by the use of anti-VEGF agents, because the choriocapillaris needs a constant VEGF level to nourish the retina.
The CATT and IVAN studies, where monthly treatment was compared with as-needed dosing, offer some evidence of the potential association of higher doses of anti-VEGF with a higher rate of atrophy.
“A high rate of atrophy occurred within the relatively short study period and in a higher proportion in eyes with monthly treatment. No difference was shown between drugs,” Holz said.
Not only underdosing but also overdosing might be a disadvantage in terms of accelerating or triggering atrophy, he said.
“When looking at risk factor for the development of atrophy, the regimen is the most important factor, and monthly treatment is not the way to go,” he said.
Holz recommended pursuing combined treatments, targeting choroidal neovascularization, atrophy and fibrosis.
Disclosure: Holz is a consultant to Novartis, Genentech, Alcon and Bayer.