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Anti-VEGF therapy for AMD inconsistently managed worldwide in real-life practice

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Anti-VEGF therapy for age-related macular degeneration has been a major breakthrough in the battle against vision loss. The pivotal MARINA and ANCHOR trials showed a mean increase of 7 to 11 visual acuity letters at 1 year, substantially maintained at 2 years, with monthly injections of ranibizumab. In clinical trial settings, optical coherence tomography-guided variable-dosing regimens achieved comparable results. In the VIEW trials, after three monthly loading doses, bimonthly administration of aflibercept produced similar improvement to monthly ranibizumab.

However, both the HORIZON and SEVEN-UP studies, which observed over the long term MARINA and ANCHOR trial patients, showed evidence that less rigorous follow-up patterns, with Lucentis (ranibizumab, Genentech) administered at the investigator’s discretion, led to a decline of the visual acuity gains achieved with monthly treatment. In the real world, as shown by numerous reports across continents, anti-VEGF treatment does not meet expectations and results are not up to the standards of clinical trials.

Such a discrepancy is obvious, simply because clinical trials are not a real-world situation, according to Jay S. Duker, MD, OSN Retina/Vitreous Board Member.

“Trials recruit a select motivated group of patients, and typically those patients get the opportunity to receive a treatment that they could not get otherwise. There are exclusion criteria, which prevent people with certain diseases or people who are sick or unable to comply with a strict follow-up schedule to be enrolled. This highly selected group of relatively healthy subjects are not the real world,” he said.