Abstract
Purpose. To identify the predictors of visual response to the bevacizumab treatment of neovascular age-related macular degeneration (AMD). Design. A cohort study within the Neovascular AMD Treatment Trial Using Bevacizumab (NATTB). Methods. This was a multicenter trial including 144 participants from the NATTB study. Visual outcomes measured by change in visual acuity (VA) score, proportion gaining ≥15 letters, and change in central retinal thickness (CRT) were compared among groups according to the baseline, demographic, and ocular characteristics and genotypes. Results. Mean change in the VA score was 9.2 ± 2.3 SD letters with a total of 46 participants (31.9%) gaining ≥15 letters. Change in median CRT was −81.5 μm. Younger age, lower baseline VA score, shorter duration of neovascular AMD, and TT genotype in rs10490924 were significantly associated with greater VA score improvement (P = 0.028, P < 0.001, P = 0.02, and P = 0.039, resp.). Lower baseline VA score and TT genotype in rs10490924 were significantly associated with a higher likelihood of gaining ≥15 letters (P = 0.028, and P = 0.021, resp.). Conclusions. Baseline VA and genotype of rs10490924 were both important predictors for visual response to bevacizumab at 6 months. This trial is registered with the Registration no. NCT01306591.
Highlights
Age-related macular degeneration (AMD) is the leading cause of blindness in people of 50 years of age or older in the developed countries [1, 2] and 80%–90% of severe vision loss and/or legal blindness can be attributed to neovascular AMD [3]
Bevacizumab is derived from the same antibody as ranibizumab (Lucentis, Genentech) which is a smaller antigen-binding fragment and a frequently used anti-Vascular endothelial growth factor (VEGF) drug in the treatment of AMD [8,9,10]
Several studies show that bevacizumab has longer half-life in the vitreous fluid than ranibizumab because it is a full-length monoclonal antibody [11, 12], so the use of bevacizumab may reduce the frequency of visit and treatment for patients
Summary
Age-related macular degeneration (AMD) is the leading cause of blindness in people of 50 years of age or older in the developed countries [1, 2] and 80%–90% of severe vision loss and/or legal blindness can be attributed to neovascular AMD [3]. The Neovascular Age-related Macular Degeneration Treatment Trial Using Bevacizumab (NATTB) study was the first multicenter trial designed to test the efficacy and safety of bevacizumab therapy and its validity in China. Cigarette smoking is an important environmental risk factor associated with AMD [25,26,27], and whether or not it influences the response to intravitreal bevacizumab treatment must be taken into consideration. The present study was aimed to identify the predictors of response to bevacizumab treatment of neovascular AMD via analysis of 6-month data from the NATTB study. There have been few studies regarding the predictors of response to bevacizumab treatment of neovascular AMD in China; it is necessary to elucidate the factors behind the variable response to this drug in the Chinese population. Results of this study could provide direction for evaluating the prognosis of neovascular AMD patients after bevacizumab treatment, provide basis so that patients can have appropriate expectations before receiving bevacizumab treatment, and provide access to the mechanism of influence of patients and disease characteristics on anti-VEGF drugs
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