Predictors of visual and anatomical outcomes for neovascular age-related macular degeneration treated with bevacizumab

Abstract

Abstract. The present study aimed to evaluate the predictive factors for visual and anatomical outcomes in neovascular age-related macular degeneration (AMD) patients treated with intravitreal bevacizumab (IVB). A total of 113 patients with neovascular AMD received IVB treatment. The best corrected visual acuity (BCVA), central retinal thickness (CRT) and total macular volume (TMV) were assessed before the injection, and at 1, 2, 3 and 9 months after surgery. Changes in BCVA and these optical coherence tomography (OCT) outcomes from baseline were compared, and independent predictors were evaluated by logistic regression models. During the treatment, logarithm of the minimum angle of resolution (logMAR) significantly decreased from 1.12 to 0.83, and reductions in OCT parameters were earlier and larger. Baseline BCVA was associated with the changes in BCVA and CRT, whereas baseline OCT features significantly affected their own changes. Larger baseline logMAR and OCT features were more likely to experience a greater proportion of ≥50 µm reduction in CRT (P<0.05). The BCVA decreases were positively associated with the reductions in CRT (r=0.34, P<0.01) and TMV (r=0.41, P<0.01). Among patients with neovascular AMD, IVB resulted in earlier significant decreases in TMV and CRT, suggesting that these OCT anatomical outcomes may be considered as more sensitive responders to evaluate the treatment effects of bevacizumab.

A Real-World, Multicenter, 6-Month Prospective Study in Greece of the Effectiveness and Safety of Ranibizumab in Patients with Age-Related Macular Degeneration Who Have Inadequately Responded to Aflibercept: The “ELEVATE” Study

“… 40 , 41 Specifically, both in patients with classic CNV and in those with baseline CRT >300 μm, the CRT decrease from baseline to 6 months post-baseline nearly reached (49.59 μm for the classic CNV subgroup) or exceeded (53.75 μm for those with baseline CRT >300 μm) the 50 μm cut-off used to define a clinically relevant significant reduction in a previous study. 41 …”

“…Notably, in ELEVATE, greater decreases in CRT were found to be associated with the presence of classic versus occult CNV and greater baseline CRT (>300 μm), with the latter reported as a predictor of anatomical outcomes in other studies as well. 40,41 Specifically, both in patients with classic CNV and in those with baseline CRT >300 μm, the CRT decrease from baseline to 6 months post-baseline nearly reached (49.59 μm for the classic CNV subgroup) or exceeded (53.75 μm for those with baseline CRT >300 μm) the 50 μm cut-off used to define a clinically relevant significant reduction in a previous study. 41 Regarding visual acuity assessments, a statistically significant median gain of 3.2 letters was found in ELEVATE at 6 months post-baseline, with 17% of the eyes experiencing clinically meaningful increases of ≥15 letters, 37.5% gaining ≥5 letters, and 82% having stable or improved BCVA.…”

“…40,41 Specifically, both in patients with classic CNV and in those with baseline CRT >300 μm, the CRT decrease from baseline to 6 months post-baseline nearly reached (49.59 μm for the classic CNV subgroup) or exceeded (53.75 μm for those with baseline CRT >300 μm) the 50 μm cut-off used to define a clinically relevant significant reduction in a previous study. 41 Regarding visual acuity assessments, a statistically significant median gain of 3.2 letters was found in ELEVATE at 6 months post-baseline, with 17% of the eyes experiencing clinically meaningful increases of ≥15 letters, 37.5% gaining ≥5 letters, and 82% having stable or improved BCVA. The SAFARI study reported median gains of 1 letter after 6 months of treatment in eyes switched to ranibizumab after poor response to aflibercept, with 11% of the study eyes gaining ≥15 letters.…”

Effects of intravitreal injection of netrin-1 in retinal neovascularization of streptozotocin-induced diabetic rats

“… 34 , 35 Many prospective randomized clinical trial data have shown that the use of VEGF inhibitors – such as ranibizumab and bevacizumab (Avastin) – is an effective treatment for retinal vascular diseases. 35 – 37 Despite the success of drugs in the treatment of DR, the exact mechanisms have only been partly resolved. Previous studies have revealed that VEGF-A is the best-studied inducer of ocular angiogenesis and vascular permeability and is crucial for the further development of early DR. 38 – 40 STZ-induced diabetes in rats is a widely used model to study the signs of early DR.…”

Faricimab (Vabysmo)

“…In a study in Chinese patients with nAMD receiving anti-VEGF treatment (N = 113), there was a moderate correlation 58 between change from baseline to month 9 in CRT measured with SD-OCT and BCVA measured in logMAR units (Pearson correlation coefficient of 0.34). 60 In a prospective cohort study (N = 1,142) within the Comparison of AMD Treatments Trials (CATT), a non-linear relationship was observed between TD-OCT-measured CRT and visual acuity assessed with a computerized version of the ETDRS. 61 In pooled data taken from 4, 12, and 24 weeks after initiation of treatment, eyes with CRT of less than 120 µm or greater than 212 µm had worse visual acuity than eyes with a CRT in the range of 120 µm to 212 µm (i.e., the range of values within 2 standard deviations of the mean measured for healthy eyes).…”