July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Outcomes of suspending VEGF inhibitors for neovascular age-related macular degeneration when lesions have been inactive for 3 months
Author Affiliations & Notes
  • Vuong Nguyen
    Save Sight Institute, Sydney, New South Wales, Australia
  • Anagha Vaze
    Save Sight Institute, Sydney, New South Wales, Australia
  • Samanta Fraser-Bell
    Save Sight Institute, Sydney, New South Wales, Australia
  • Jennifer Joan Arnold
    Marsden Eye Specialists, New South Wales, Australia
  • Rohan W Essex
    Australian National University, Australian Capital Territory, Australia
  • Daniel Barthelmes
    University Hospital Zurich, Switzerland
  • Mark C Gillies
    Save Sight Institute, Sydney, New South Wales, Australia
  • Footnotes
    Commercial Relationships   Vuong Nguyen, None; Anagha Vaze, None; Samanta Fraser-Bell, None; Jennifer Arnold, Bayer (R), Novartis (R); Rohan Essex, None; Daniel Barthelmes, Bayer (F), Novartis (F); Mark Gillies, Bayer (F), Novartis (F)
  • Footnotes
    Support  Macular Disease Foundation, Australia
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 139. doi:https://doi.org/
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    • Get Citation

      Vuong Nguyen, Anagha Vaze, Samanta Fraser-Bell, Jennifer Joan Arnold, Rohan W Essex, Daniel Barthelmes, Mark C Gillies; Outcomes of suspending VEGF inhibitors for neovascular age-related macular degeneration when lesions have been inactive for 3 months. Invest. Ophthalmol. Vis. Sci. 2019;60(9):139. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : There is currently limited evidence that it is ever safe to suspend anti-VEGF treatment for nAMD. We assessed the outcomes of eyes that have suspended treatment with vascular endothelial growth factor (VEGF) inhibitors for neovascular age-related macular degeneration (nAMD).

Methods : Eyes enrolled in the Fight Retinal Blindness! registry that commenced anti-VEGF treatment for nAMD from 1st January 2006 onwards were identified. An eye was considered to have suspended treatment if they received a minimum of 5 injections, followed by a ≥3 month documented period of inactivity of the choroidal neovascular lesion with no treatments administered. Only eyes with at least 12 months of follow-up after treatment were considered.
The primary outcome measures were the proportion of eyes resuming treatment due to lesion re-activation following suspension of treatment, change in visual acuity (VA) at time of re-activation and recovery of vision 12 months after resuming treatment.

Results : We identified 434 eyes that suspended treatment with VEGF inhibitors and were tracked for at least 12 months thereafter. The estimated percentage of eyes re-activating in the first year following treatment suspension was 41%, increasing to 79% by the fifth year. The median time to re-activation was 504 days. Of the 275 eyes whose lesion was observed to re-activate at any time following treatment suspension, there was a mean loss of 4.2 letters (95% confidence interval [CI]: -5.6, -2.8; P < 0.001) from the last injection at time of re-activation; 206 eyes resumed treatment for at least 12 months after re-activation of the lesion and recovered a mean of +1.2 letters (95% CI: -0.4, 2.7; P = 0.133), resulting in a net loss of 3.3 letters (95% CI: 2.3, 5.1; P < 0.001) compared with VA at treatment suspension. Lower VA at time of suspension and longer duration on treatment prior to suspension were associated with reduced risk of re-activation. Median time to re-activation was substantially greater when eyes were on treatment for at least 3 years prior to suspension.

Conclusions : Fewer than half of the eyes with treatment suspension re-activated in the first year, but most re-activated by the fifth year. Caution should be exercised to avoid suspending treatment prematurely. Further research is warranted to identify which eyes might be able to suspend treatment safely.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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