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Erika Tanaka, Voraporn Chaikitmongkol, Susan Bressler, Neil Bressler; Longer Term Safety Outcomes (4 or More Years) After Initiating Anti-Vascular Endothelial Growth Factor Therapy for Neovascular Age-related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3168.
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To assess longer term safety outcomes (4 or more years) after initiating anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (AMD).
Retrospective review of clinical data, fundus photos, and fluorescein angiograms from patients with neovascular AMD first treated with intravitreal anti-VEGF therapy during November 2005 to June 2008, and followed for at least 4 years (+/-6 months) at a university-based practice of two retina specialists (SBB, NMB).
Among 576 neovascular AMD patients treated since anti-VEGF therapy became available, 75 patients (81 eyes) were followed for at least 4 years after initiating treatment (usually ranibizumab, usually in a PRN regimen). 59% were women, mean age was 77 years. Mean follow-up was 4.9 years (range, 3.6-6.6 years). Presenting median visual acuity (VA) with present correction on ETDRS charts was 20/80 (interquartile range (IQR): 20/50, 20/100); at 4 years it was 20/80 (IQR: 20/40, 20/200). 7 eyes (8%) progressed to a predominantly blood lesion within 4 years of treatment initiation (median 2.4 years (IQR: 0.8, 2.8 years) and 2 eyes after 4 years (4.6, 5.8 years). No eye developed geographic atrophy (GA) outside the boundary of a CNV lesion. Among the 8 eyes that presented with GA non-contiguous to the CNV lesion, all had enlargement of the GA. Excluding 8 eyes receiving treatment for intraocular pressure (IOP) at baseline, 6 eyes (8%) required IOP management prior to 4 years and 2 eyes (3%) after 4 years (both at 60 months). 4 patients (5%) had myocardial infarctions (all prior to 4 years), 3 patients (4%) had cerebrovascular accidents (1 prior to 4 years), 3 patients (4%) had transient ischemic attacks (all prior to 4 years), and 1 patient (1%) was hospitalized for gastrointestinal hemorrhage at 60 months.
Longer term follow-up of patients treated with anti-VEGF drugs for neovascular AMD suggests that instances of predominantly blood lesions continue to occur, while development of GA independent of CNV are uncommon. Frequency of serious local or systemic adverse events of interest seems consistent with expectations in this age group.
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