Researchers Estimate Lifetime Outcomes of Anti-VEGF Treatment for nAMD

Anti–vascular endothelial growth factor (VEGF) treatment was associated with preserved useful visual acuity (VA) in almost 20% of patients with neovascular age-related macular degeneration (nAMD) over their average remaining lifetime, according to a study published in JAMA Ophthalmology.

In comparison, of those with the disease who do not receive an intervention, 80% will become legally blind within 3 years of disease onset. Late-stage nAMD is the largest single cause of irreversible, severe vision loss in all high-income countries.

“Because anti-VEGF treatment does not cure nAMD but only controls it, treatment is for the long term and is often required until either the eye worsens to levels where treatment is no longer considered beneficial or the patient dies,” researchers wrote.

However, long-term studies on the retainment of useful VA are scarce. To better understand the lifetime outcomes of anti-VEGF treatment for nAMD, researchers used multistate models (MSMs) and patient data to evaluate the sample’s outcomes over their average remaining lifetime.

Data from 3192 patients were included in the retrospective analysis of an observational study. All patients had commenced intravitreal therapy for nAMD in routine clinical practice and were prospectively tracked in the Flight Retinal Blindness (FRB) database. All individuals resided in Australia, New Zealand or Switzerland, were over the age of 55, had been diagnosed with nAMD and received anti-VEGF treatment between 2007 and 2015.

For both eyes, individuals, 3 categories of vision impairment (VI) were calculated: 1) no VI (VA ≥ 20/40); (2) mild VI (< 20/40 to 20/60); and (3) moderate to severe VI (VA < 20/60). “These cutoffs were chosen because 20/40 is the cutoff for driving VA in most countries and 20/60 is a cutoff for comfortable reading VA (no need for magnifying aids),” authors said.

The majority of patients were female (63%) while most were 80 years or older at baseline. Analyses revealed:

• For the mean remaining lifetime of 11 years, an estimated 12% (n = 371; 95% Confidence Interval [CI], 345-400) of the sample retained driving VA and an estimated 15% (n = 463; 95% CI, 434-495) reading VA in at least 1 eye
• At that time, an estimated 82% of the sample (n = 2629; 95% CI, 2590-2660) had dropped out
• Younger age at baseline and more injections during the first year of treatment were associated with better long-term outcomes

“These findings emphasize that ongoing anti-VEGF treatment is associated with better outcomes and prevention of severe vision loss in a considerable proportion of patients in the long term,” researchers wrote. “It also highlights that a large proportion of patients cease treatment for various reasons, and more work is required to lower this proportion.”

The comparatively small sample size for the modeling study, the relatively short follow-up and the attrition of patients over time all mark limitations to the study. Authors also caution against generalizing results to samples with different sex or age distributions, injection frequencies, or a different substitution of baseline VA.

“Given the almost uniformly rapid progressive vision loss associated with the natural history of nAMD, this is a remarkable outcome for any chronic disease, underlining the public health necessity of providing anti-VEGF treatment to persons in need as early as possible,” researchers concluded.

Reference:

Finger RP, Puth M, Schmid M, Barthelmes D, Guymer RH, Gillies M. Lifetime outcomes of anti-vascular endothelial growth factor treatment for neovascular age-related macular degeneration. JAMA Ophthalmol. Published online October 15, 2020. doi:10.1001/jamaophthalmol.2020.3989