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  • Predicting Two-Year Outcomes of Anti-VEGF Therapy for AMD

    By Lynda Seminara
    Selected by Andrew P. Schachat, MD
    Retina/Vitreous
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    Journal Highlights

    Ophthalmology Retina, July 2023

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    In the multicenter Comparisons of Age-Related Macular Degeneration (AMD) Treatments Trials (CATT), safety and efficacy were assessed for ranibizumab and bevacizumab. Given the wide variability of treatment responses, it is prudent to identify factors that may affect outcomes. In a secondary cohort analysis of CATT, Xue et al. looked at the early morphologic and functional responses to explore their potential for predicting two-year visual outcomes. They found that new elevation of the retinal pigment epithelium within three months of treatment coincided with significantly better BCVA gains within two years. Most of the early structural responses were not independent pre­dictors of visual outcomes. The combi­nation of baseline factors, early BCVA response, and morphologic findings at three months was moderately predic­tive of two-year visual outcomes.

    The cohort comprised 1,185 patients with treatment-naïve neo­vascular AMD and baseline BCVA in the range of 20/25 to 20/320. Per the study protocol, participants were assigned randomly to receive a regi­men of ranibizumab or bevacizumab. In the secondary analysis, the authors looked for links between two-year BCVA results and the morphologic and functional observations at baseline and three months. They applied univariable and multivariable regression models to assess the performance of each variable for predicting overall BCVA change and BCVA gains of at least three lines (the primary outcomes), using the R2 coefficient and area under the receiver– operating characteristic curve (AUC), respectively.

    In multivariable analyses that included known significant baseline predictors of treatment outcomes (e.g., BCVA, macular atrophy, retinal pig­ment epithelium elevation [RPEE]) and an early favorable BCVA response, new RPEE within three months correlated significantly with higher BCVA gains by two years (10.2 letters vs. 3.5 letters for resolved RPEE; p < .001). This combination of significant predictors was found to moderately forecast the two-year BCVA (R2 = 0.36). Baseline BCVA plus gains of at least three lines by month 3 predicted gains of this mag­nitude within two years (AUC, 0.83; 95% CI, 0.81-0.86).

    No other three-month morphologic change was a significant predictor of two-year visual response, said the au­thors. They noted that “future research is needed to better understand the factors contributing to the variation in long-term vision outcomes with anti-VEGF therapy.” 

    The original article can be found here.