Abstract
Purpose :
The evidence on the efficacy and safety of anti-vascular endothelial growth factor (VEGF) for neovascular age-related macular degeneration (nAMD) is constantly growing as large clinical trials and observational studies are continually completed and results are published. The purpose of the present study is to analyze 12-month best-corrected visual acuity (BCVA) outcomes in response to anti-VEGF therapy and to identify factors affecting treatment response using evidence generated from meta-regression.
Methods :
A review of electronic databases (EMBASE, MEDLINE, MedMEME) was conducted to identify randomized controlled trials and observational studies that reported 12-month changes in BCVA (mean and standard deviation) in patients with naïve nAMD on anti-VEGF treatment. Study factors that were analyzed are baseline patient characteristics, study type, sample size, drug employed, number of injections and 12-month change in BCVA. Data were pooled in a meta-analysis with BCVA change as main outcome. Meta-regression was conducted to assess the impact of multiple covariates.
Results :
Two hundred fifty five heterogeneous study populations (93,167 eyes) were identified and included in the analysis. The use of anti-VEGFs induced an overall increase of 5.01 ETDRS letters (95% confidence interval: 4.73–5.29) in BCVA at 12 months of follow-up. Meta-regression provides evidence that mean BCVA change was higher for randomized control trials (p<0.0001) compared to observational studies. Populations following a proactive treatment regimen performed better than those following a reactive treatment regimen (p=0.005).
Mean BCVA gain was higher in younger populations (p<0.0003), with lower baseline BCVA (p<0.0001) and thicker baseline central retinal thickness (p=0.0035), receiving an higher number of injections (p<0.0001).
Conclusions :
Our analysis strongly suggests that intravitreal anti-VEGF treatment produces a significant improvement in BCVA at 12 months in patients with naïve nAMD. Meta-regression identified the modifiable covariates that can be targeted in order to maximize functional results.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.