June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Poor response to anti-VEGF treatment in macular edema secondary to central retinal vein occlusion and its baseline predictors: a post hoc analysis of COPERNICUS and GALILEO
Author Affiliations & Notes
  • Carmelina Gordon
    Specialty Eye Institute, Jackson, Michigan, United States
  • Footnotes
    Commercial Relationships   Carmelina Gordon Alcon, Alimera, Allergan, Genentech, NIH, Novartis, Regeneron Pharmaceuticals, Inc., Santen Pharmaceutical Co., Ltd., and Topco, Code F (Financial Support)
  • Footnotes
    Support  Regeneron Pharmaceuticals, Inc.
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 1757 – F0217. doi:
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    • Get Citation

      Carmelina Gordon; Poor response to anti-VEGF treatment in macular edema secondary to central retinal vein occlusion and its baseline predictors: a post hoc analysis of COPERNICUS and GALILEO. Invest. Ophthalmol. Vis. Sci. 2022;63(7):1757 – F0217.

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

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Abstract

Purpose : To characterize poor responders to intravitreal aflibercept injection (IAI) following 24-week treatment, evaluate their longer-term visual and anatomic outcomes through week 52, and identify baseline factors associated with poor response in patients with macular edema secondary to central retinal vein occlusion (MEfCRVO).

Methods : Patients with MEfCRVO who received IAI 2 mg every 4 weeks for 24 weeks followed by pro-re-nata (PRN) dosing from Week 24 through Week 52 in COPERNICUS and GALILEO were analyzed post hoc. Poor response at Week 24 was defined by a combination of visual acuity (<58 letters [Snellen <20/80] or ≤5 letters gain from baseline) and anatomic criteria (central subfield thickness [CST] ≥300 µm or presence of intraretinal or subretinal fluid). All other patients were considered responders. Univariate analysis examined baseline factors (sex, ethnicity, race, age, BMI, perfusion status, time since diagnosis, BCVA and CST) associated with poor response at Week 24.

Results : Of 217 eligible IAI-treated patients,18 (8.3%) were poor responders, 184 (84.8%) were responders, and 15 (6.9%) were indeterminate at Week 24. Baseline characteristics were comparable between the two groups with the exception of lower mean BCVA for poor responders vs responders (42.1 vs 52.7; P=0.0145). Poor responders vs responders received more PRN injections through Week 52 (4.2 vs 2.5; P<0.05). Mean difference (95% CI) in absolute BCVA between poor responders vs responders was −23.3 (−30.2, −16.4) letters at Week 24 and −22.3 (−29.8, −14.8) letters at Week 52. A lower proportion of poor responders vs responders had gain of ≥5 letters (61.1% vs 88.6%), ≥10 letters (50.0% vs 81.1%) and ≥15 letters (16.7% vs 66.9%) at Week 52. Mean difference (95% CI) in absolute CST between poor responders vs responders was 77.7 (24.3, 131.1) µm at Week 24 and 40.7 (−12.8, 94.2) µm at Week 52. The odds of having a poor response at Week 24 decreased by 21% for every 5-letter increase in baseline BCVA (P=0.0062).

Conclusions : A small proportion of patients with MEfCRVO had poor response to IAI at Week 24 in COPERNICUS and GALILEO. These patients had smaller BCVA gains at Week 52 despite similar reduction in CST and receiving more PRN injections. Baseline vision was a key predictor of poor response at Week 24.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

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