Author: Kimberly Spooner (Australia)
Co-authors: Samantha Fraser-Bell, Thomas Hong, James Wong, Andrew Chang
To analyze the functional and morphological changes in patients discontinuing or suspending treatment with vascular endothelial growth factors (VEGF) for neovascular age-related macular degeneration (nAMD).
Retrospective, observational case series.
The medical records of eyes who received anti-VEGF therapy for nAMD were searched for eyes that discontinued, or suspended treatment for a minimum of 6 months. The visual acuity (VA) and central macular thickness (CMT) at treatment discontinuation and/or suspension were compared with VA at 1- and 2- years post discontinuation/ suspension in treatment.
A total of 187 eyes were identified and observed for up to 2-years post discontinuation/suspension in anti-VEGF treatment. The mean number in anti-VEGF injections before discontinuing treatment was 13.8±3.5 (95% CI 8.4 to 17.2 injections). Eighty-one (42%) eyes resumed therapy with a mean loss of 6.4±7.2 (95% CI -1.2 to -0.6 letters; P < 0.01) letters from their last injection before the suspension. These patients recovered +2.1 and +1.4 letters at years 1 and 2, respectively, resulting in a net loss of -5.0 letters [95% CI 2.9 – 7.2 letters; P < 0.01] from treatment suspension and +4.9 letters (95% CI -1.9 to 7.8 letters; P < 0.01) from diagnosis. The 106 eyes that permanently discontinued therapy had gained 6.2 letters (95% CI 4.3 to 8.1 letters; P < 0.01) after 1-year of treatment and lost 0.8 letters (95% CI -0.2.1 to 0.5 letters; P < 0.01) at discontinuation. After stopping treatment, these patients lost a further 3.4 and 7.0 letters at 1- and 2- years post-discontinuation, respectively. These eyes had a mean -1.6 letter loss (95% CI -4.5 to 1.3 letters; P < 0.01) from diagnosis.
Marked deterioration in visual acuity was noted in patients discontinuing anti-VEGF therapy after 1- and 2-years. The eyes that resumed treatment were able to regain some visual acuity and maintain this for up to 2-years post suspension of therapy; however, the visual acuity is mostly irreversible.
K. Spooner: At time of writing research, KS was an employee of Sydney Retina, at time of presentation KS is an employee of Allergan Australia. S.Fraser-Bell is a consultant Novartis, Allergan, Roche and Bayer. A.Chang is a consultant for Novartis, Allergan, Roche and Bayer.