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Norihiro Nagai, Misa Suzuki, Atsuro Uchida, Toshihide Kurihara, Mamoru Kamoshita, Sakiko Minami, Hajime Shinoda, Kazuo Tsubota, Yoko Ozawa; Predictive factors for non-response to intravitreal aflibercept treatment in neovascular age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3689.
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To study the baseline characteristics and response to intravitreal aflibercept (IVA) monotherapy of neovascular age-related macular degeneration (AMD).
We reviewed the clinical records of 133 eyes in 133 AMD patients who received monthly IVA for 3 months and thereafter pro re nata (PRN) injections for 9 months. Sixty-two patients were initially treatment naïve (naïve group), and 71 patients had been received other treatments before IVA treatment (switched group). Patients with increased exudative fundus findings or central retinal thickness (CRT) of more than 100 μm at month 12, or no decrease of CRT during treatment were considered to be non-responders as judged by fundus findings. Patients whose best corrected visual acuity (BCVA) worsened at month 12 were considered to be non-responders as judged by BCVA. Non-responders’ baseline characteristics were analyzed using logistic regression models. In the multivariable analysis, potential risk factors for non-responders were adjusted for age, CRT, and greatest linear dimension at baseline. The study followed the tenets of the Declaration of Helsinki and was approved by the ethics committee of Keio University School of Medicine (2010002) and registered as UMIN000007649.
IVA treatment significantly decreased CRT both in naïve and switched group. Although BCVA of naïve group was significantly improved, that of switched group was not changed. Non-responders as judged by fundus findings was 12.9% and 5.6%, and those by BCVA was 9.7% and 15.5%, in naïve and switched groups, respectively. Serous pigment epithelial detachment at baseline was associated with non-response as judged by fundus findings in naïve group (Odds ratio (OR) 23.0, 95%CI 2.69-192) and those by BCVA in the switched group (OR 5.14, 95%CI 1.16-22.8). Female gender was associated with non-response as judged by BCVA in the naïve group (OR 6.88, 95% CI 1.07 to 44.1).
Although most AMD patients responded to IVA, there were non-responders whose baseline characteristics may be informative for managing their treatment.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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