Long-term outcomes of intravitreal anti-VEGF therapies in patients affected by neovascular age-related macular degeneration: a real-life study

Paolo Corazza,Jamil Kabbani,Stefano Mercuri,Harry Otway Orlans,Saad Younis,Francesco Maria D’Alterio,Mostafa Mohamed Ragheb Alam

doi:10.1186/s12886-021-02055-6

Abstract

PurposeTo describe real-life data from wet age-related macular degeneration (AMD) patients treated with anti-vascular endothelial growth factors (VEGFs) and to compare our results with previous studies and clinical trials.MethodsThis retrospective monocentric cohort study analyzed 865 eyes of 780 wet-AMD patients treated with an anti-VEGF treat-and-extend regimen over a long-term follow-up period. Aflibercept and Ranibizumab were considered first-line agents whereas Bevacizumab was reserved for use on a compassionate basis in patients not meeting treatment criteria. All patients underwent a best corrected visual acuity (BCVA) assessment at each follow-up visit.ResultsOne-year follow-up figures were available for 82.5% of patients, whilst follow-up data was recorded for 55.6%, 37.6%, 25.1%, and 15.0% of the cohort at years 2, 3, 4, and 5 respectively. Patients treated with Bevacizumab received fewer yearly injections than those treated with Ranibizumab. However, no significant difference in the number of injections per year was detected in other comparisons between groups. Whilst our data showed no significant difference in mean BCVA between the three groups, there was a gradual deterioration of visual function over time for the patient cohort as a whole.ConclusionNo significant differences between the 3 anti-VEGF molecules were recorded in wet-AMD patients in real-life conditions. Despite the long-term therapy, we found a slight reduction in visual function especially after the third year of treatment.

Highlights

Age-related macular degeneration (AMD) is currently considered to be one of the chief causes of irreversible visual loss in developed countries, with an estimated 7% of global blindness being attributable to this condition [1,2,3]
The purpose of our study is to describe real-world outcomes in wet AMD patients treated with anti-vascular endothelial growth factor (VEGF) therapy over a long follow-up period, and to compare these results with those published by other centers and with clinical trial data
Our TEX protocol for Ranibizumab and Aflibercept is summarized as follows: new patients began the treatment with a loading phase of three monthly injections, the treatment was continued on a monthly basis for Ranibizumab and on a bimonthly basis for Aflibercept until any macular hemorrhages previously seen on slit lamp biomicroscopic examination had disappeared, and intraretinal fluid (IRF) and/or subretinal fluid (SRF) on optical coherence tomography (OCT) had resolved or was stable compared to the previous two visits

Summary

Introduction

Age-related macular degeneration (AMD) is currently considered to be one of the chief causes of irreversible visual loss in developed countries, with an estimated 7% of global blindness being attributable to this condition [1,2,3]. Three VEGFtargeting molecules have gained worldwide acceptance for intravitreal use in the treatment of neovascular AMD: Bevacizumab, a recombinant humanized monoclonal antibody; Ranibizumab, a monoclonal antibody fragment; and Aflibercept, a recombinant fusion protein consisting of the binding domains of VEGF receptors 1 and 2 together with the Fc portion of the human IgG1 immunoglobulin. Together these molecules represent the first-line therapy for wet AMD [8], with many largescale and well-run clinical trials demonstrating their safety and efficacy [9,10,11]. The purpose of our study is to describe real-world outcomes in wet AMD patients treated with anti-VEGF therapy over a long follow-up period, and to compare these results with those published by other centers and with clinical trial data

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Results

Conclusion