Profiles of wAMD patients associated with the number of intravitreal injection: a pooled analysis from the real-world LUMIERE &TWIN retrospective studies

Abstract

Purpose: Although the mean number of intravitreal treatments (IVTs) was reported to be about 5-6 per year, the distribution pattern of the number of IVTs in patients with neovascular age-related macular degeneration (nAMD) in the real-world setting remains to be defined. In line with this, the baseline predictive factors remain unidentified to determine this number required for a patient. This pooled retrospective analysis from the LUMIERE and TWIN studies aims at describing the distribution pattern of number of IVTs and the characteristics of these patients.

Methods: LUMIERE (N=551) and TWIN (N=881) were similar designed multicenter 12-month retrospective observational studies to evaluate the functional and morphological outcomes in the clinical settings of patients with nAMD treated with ranibizumab (RBZ). Patients were pooled and divided into 3 groups as per the number of IVTs: <5, 5-6, and ≥7. The baseline characteristics and the response to RBZ with respect to change in best-corrected visual acuity (BCVA; Early Treatment Diabetic Retinopathy [ETDRS] letters) from baseline to Month 12 were analyzed.

Results: 39.6%, 31.8%, and 28.6% of patients received <5, 5-6, and ≥7 IVTs, respectively. Overall, the majority (65.9%) was females; mean age (78.9 years) was similar across all the 3 groups. The mean baseline BCVA was significantly lower in the <5 IVT group compared to the other 2 groups (<5IVTs: 53.4 ± 20.2, 5-6IVTs: 56.5 ± 17.8, and ≥7 IVTs: 57.4 ± 16.8 (p<0.001)). A global difference seems to be present at baseline in each group regarding the types of choroidal neovascularization without the possibility in this posthoc analysis to identify it separately. Over 32% of the patients in ≥7 IVT group had vascularized pigment epithelial detachment (versus <5IVTs: 20%, 5-6IVTs: 25%, p<0.001). At Month 12, the mean change in BCVA ± SD compared with baseline was comparable across the 3 groups (<5IVTs: 5.3 ± 15.2, 5-6IVTs: 3.5 ± 15.3, and ≥7 IVTs: 4.2 ± 14.7 (p=0.773)).

Conclusions: This pooled analysis from the LUMIERE and TWIN studies in nAMD showed that only about one-third of patients received 5-6 IVT. This indicates that the mean number of IVT per year correlates with a minority of patients (32%).<br /> Real life analysis revealed a broad distribution pattern of the number of injections, supporting individualized dosing.