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Priyatham S Mettu, Michael J Allingham, Peter C Nicholas, Scott W Cousins; Neovascular Morphology by ICG Angiography and Response to Loading-Dose Anti-VEGF Therapy in Patients with Neovascular AMD. Invest. Ophthalmol. Vis. Sci. 201657(12):.
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© ARVO (1962-2015); The Authors (2016-present)
To determine rates of persistent disease activity (PDA) in neovascular AMD (NV AMD) patients following loading dose treatment (three monthly consecutive intravitreal injections) with aflibercept or bevacizumab; and to determine the relationship between treatment response and neovascular morphology as determined by indocyanine green angiography (ICGA).
This study included (1) a prospective, open-label, single-arm clinical study of patients with newly diagnosed NV AMD who underwent loading-dose with aflibercept; and (2) historical comparator group of NV AMD patients treated with bevacizumab derived from a retrospective analysis of NV AMD patients at the Duke Medical Retina practice. For both populations, disease activity was assessed by clinical exam, optical coherence tomography (OCT), and fluorescein angiography (FA), before and after therapy, using a categorical “disease activity scale.” Response to anti-VEGF therapy was stratified by ICGA morphologic subtype.
Among the aflibercept cohort (n=28), the distribution of ICGA subtypes was capillary 25%, branching vascular arteriolar complex (BAVC) 28.6%, polypoidal choroidal vasculopathy (PCV) 10.7%, atypical central serous chorioretinopathy (CSR) 3.6%, retinal angiomatous proliferation (RAP) 7.1%, abnormal vascularity without distinct morphology 7.1%, and no lesion 17.9%. Among the bevacizumab cohort (n=110), the distribution of ICGA subtypes was capillary 23.7%, BAVC 28.2%, PCV 24.5%, atypical CSR 10.9%, RAP 1.8%, abnormal vascularity without distinct morphology 2.7%, and no lesion 8.2%. Only 14.2% of the aflibercept cohort versus 36.4% of bevacizumab cohort demonstrated moderate / severe PDA. In the bevacizumab cohort, the majority of eyes with PDA demonstrated BAVC (50%) or PCV (22.5%). In the aflibercept cohort, 3 of 4 PDA cases demonstrated BAVC. However, preliminary analysis of the aflibercept cohort suggests that presence of the BAVC subtype at diagnosis predicts greater rate of disease re-activation during “extension” beyond 8 weeks treatment interval.
Among NV AMD patients, rate of PDA following loading-dose therapy was considerably lower for aflibercept as compared to bevacizumab. BAVC subtype appears to predict higher rate of PDA or re-activation following intravitreal anti-VEGF therapy.
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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