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J. H. Lim, S. S. Wickremasinghe, D. S. Chauhan, J. Xie, L. D. Robman, A. J. Richardson, P. N. Baird, R. H. Guymer; Predictors of Treatment Outcomes With Anti-Vascular Endothelial Growth Factor in Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1892.
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Ranibizumab and bevacizumab are anti-VEGF drugs that have revolutionised the treatment of neovascular AMD. 10% of patients, however, continue to lose vision despite treatment. The purpose of our study is to investigate whether factors related to the individual, the lesion or the treatment scheduling influence 6-month visual acuity (VA) outcomes after anti-VEGF therapy.
We administered questionnaires/information sheets to collect data regarding patient demographics, treatment delays, VA and number of treatments. Determination of the ApoE, CFH, LOC387715 and HTRA1 genetic polymorphisms, associated with AMD risk, was performed using the Sequenom MassARRAY platform.
Female gender was a statistically significant predictor of poor treatment outcome (OR 2.68) when controlling for age, treatment delay from first CNV symptoms, baseline VA and genotype (p=0.04). A longer treatment delay from first CNV symptoms was significantly predictive of poor treatment response (OR 3.51), when adjusting for other variables (p=0.02). The ApoE E2 risk allele had a statistically significant association (OR 3.54) for decreased VA following anti-VEGF treatment in multivariate analysis (p=0.02).
It is clear that a critical public health message needs to reach those at risk of vision loss from AMD and health care providers to minimise delay from symptom onset to treatment. For the first time, we have shown that patients with the at-risk ApoE genotype are less likely to do well, possibly due to overexpression of VEGF in the RPE, as seen in ApoE E2 transgenic mice. Therefore, our study raises the possibility of a personalised treatment protocol based on a patient's genotype.
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