June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Author Affiliations & Notes
  • Szilard Kiss
    Ophthalmology, Weill Cornell Medical College, New York, NY
    Avalanche Biotechnologies, Inc., Menlo Park, CA
  • Samuel B. Barone
    Avalanche Biotechnologies, Inc., Menlo Park, CA
  • Steven Butler
    Avalanche Biotechnologies, Inc., Menlo Park, CA
  • Sherri Van Everen
    Avalanche Biotechnologies, Inc., Menlo Park, CA
  • Melvin Rabena
    Avalanche Biotechnologies, Inc., Menlo Park, CA
  • Roman Rubio
    Avalanche Biotechnologies, Inc., Menlo Park, CA
  • Thomas Walter Chalberg
    Avalanche Biotechnologies, Inc., Menlo Park, CA
  • Footnotes
    Commercial Relationships Szilard Kiss, Avalanche Biotechnologies, Inc. (E), Avalanche Biotechnologies, Inc. (F), Avalanche Biotechnologies, Inc. (I); Samuel Barone, Avalanche Biotechnologies, Inc. (E), Avalanche Biotechnologies, Inc. (F), Avalanche Biotechnologies, Inc. (I); Steven Butler, Avalanche Biotechnologies, Inc. (E), Avalanche Biotechnologies, Inc. (F), Avalanche Biotechnologies, Inc. (I); Sherri Van Everen, Avalanche Biotechnologies, Inc. (E), Avalanche Biotechnologies, Inc. (F), Avalanche Biotechnologies, Inc. (I); Melvin Rabena, Avalanche Biotechnologies, Inc. (E), Avalanche Biotechnologies, Inc. (F), Avalanche Biotechnologies, Inc. (I); Roman Rubio, Avalanche Biotechnologies, Inc. (E), Avalanche Biotechnologies, Inc. (F), Avalanche Biotechnologies, Inc. (I); Thomas Chalberg, Avalanche Biotechnologies, Inc. (E), Avalanche Biotechnologies, Inc. (F), Avalanche Biotechnologies, Inc. (I), Avalanche Biotechnologies, Inc. (P)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 2837. doi:
Abstract
 
Purpose
 

Although anti-VEGF is the mainstay of therapy for exudative age-related macular degeneration (AMD), concerns have been raised over the long-term effects of sustained treatment. The purpose of this analysis is to evaluate the relationship between GA, anti-VEGF exposure and VA in CATT subjects.

 
Methods
 

Publicly available data from CATT were analyzed, including baseline characteristics, treatment group, VA, and reading center assessments (fundus photographs and OCT).

 
Results
 

Among PRN treated subjects, GA development at week 104 was negatively associated with increasing anti-VEGF exposure (P = 0.036; Figure 1A). Similar results were seen for subjects switched from monthly to PRN after 1 year (P < 0.001). Among GA subjects (GA assessed at week 26), the first GA observation was most common following the lowest anti-VEGF exposure (1-3 or 4-6 injections prior to first GA) (Figure 1B). For a subset of subjects, the presence of GA was intermittent, an observation which occurred more commonly in the PRN and switching groups compared to monthly. Multivariable logistic regression models identified GA risk factors including: fewer prior injections (PRN and switching patients), absence of fluid at 2 years, and fellow eye GA. GA was not associated with inferior vision compared to subjects with no GA. Among GA subjects, monthly treated did not have poorer VA outcomes compared to other regimens.

 
Conclusions
 

Although previous reports suggested a difference in GA between continuous and PRN anti-VEGF therapy, we investigated the relationship between the number of anti-VEGF injections, GA, and VA. GA development was not related to exposure (in the PRN and switcher groups) as it was negatively associated with the number of injections. Importantly, GA was not associated with worse VA outcomes in any treatment group, and among subjects with GA, monthly treatment did not have worse outcomes than other regimens. Retrospective analysis of publicly available data suggests GA development is multi-factorial, may not be related to anti-VEGF therapy or associated with diminished VA.  

 
Proportion of subjects with GA (with 95% C.I.) observed at 2 years according to number of injections in the pooled PRN arms (A) and the distribution of the number of injections prior to first incidence of GA (subset of patients with more frequent GA assessments) (B).
 
Proportion of subjects with GA (with 95% C.I.) observed at 2 years according to number of injections in the pooled PRN arms (A) and the distribution of the number of injections prior to first incidence of GA (subset of patients with more frequent GA assessments) (B).

 
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