No ‘one size fits all’ treatment approach for neovascular AMD
Researchers at the virtual American Society of Retina Specialists meeting reported a positive and clinically meaningful link between the number of anti-VEGF injections and change in visual acuity in patients with neovascular age-related macular degeneration.
However, there was no ‘one-size-fits-all’ approach to treating neovascular AMD therapy and advised considering the impact of treatment burden on patients, according to the presentation.
“When analyzing anti-VEGF agents in general, more injections have yielded better vision; however, this does come at the cost of a high treatment burden on patients and providers,” Rahul Komati, MD, of the University of Chicago, said in his presentation.
To determine the optimal dosing regimen, Komati and colleagues reviewed Level 1 evidence, including from FDA registration and National Eye Institute trials, on currently approved anti-VEGF agents and those in the pipeline for neovascular AMD. They assessed anti-VEGF agents and treatment dosing regimen for each study as well as data on the baseline ETDRS letters, average number of injections over a 12-month period and change in ETDRS letters over 1 year.
Researchers analyzed 23 different injection regimens from studies involving 6,860 eyes with neovascular AMD, according to the presentation. The different injection regimens were:
- ranibizumab given every 4 weeks or as needed (31.6%, n = 2,165);
- aflibercept dosed either every 4 or every 8 weeks (28.6%, n = 1,962);
- abicipar given every 8 weeks or 12 weeks (15.4%, n = 1,059);
- brolucizumab dosed at every 12 or 8 weeks (15.8%, n = 1088); and
- bevacizumab given every 4 weeks or as needed (8.7%).
Over 12 months, the average number of injections in these studies was 9.36 ± 2.66 and the average gain in ETDRS letters was 7.86 ± 1.37, Komati reported. While the agents had different durability, the researchers observed a positive correlation coefficient between the number of injections and mean change in ETDRS letters (0.6).
“A higher number of injections correlated to greater visual gains at 12 months; however, there still seems to be trouble generating a ‘one-size-fits-all’ approach to neovascular AMD therapy,” Komati said. “Patient factors and factors in our offices generate real-world limitations. On a discrete patient-to-patient level in the real world, frequent anatomical assessment of OCT with some individualization of dosing is an appropriate plan to mitigate treatment burden as much as possible.”
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Komati R, et al. Treatment burden and Vision analysis of anti-VEGF therapies for the treatment of neovascular AMD. Presented at: ASRS annual meeting; July 24-26, 2020 (virtual meeting).