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Szilard Kiss, Samuel B. Barone, Steven Butler, Sherri Van Everen, Melvin Rabena, Roman Rubio, Thomas Walter Chalberg; . Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2837.
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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.
Publicly available data from CATT were analyzed, including baseline characteristics, treatment group, VA, and reading center assessments (fundus photographs and OCT).
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.
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.
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