Predictors of treatment response after intravitreal anti-vascular endothelial growth factor therapy in neovascular age-related macular degeneration

Abstract

Purpose : To investigate predictive factors of treatment response after three loading intravitreal anti-vascular endothelial growth factor (VEGF) injections in neovascular age-related macular degeneration (AMD)

Methods : Among participants of a prospective, longitudinal, observational study, we selected patients with treatment-naïve exudative AMD that underwent 3 loading intravitreal anti-VEGF injections. Demographics and medical history were available from a standardized questionnaire obtained during study enrollment. All patients were imaged with optical coherence tomography (OCT), which were assessed by two independent graders at baseline and 4-to 6-week after 3 loading injections. At baseline, images were graded for the presence of predefined features commonly seen in AMD (such as classic drusen, subretinal drusenoid deposit, ellipsoid zone disruption, hyper-reflective foci, and presence of large pigmented epithelial detachment (PED). After 3 injections, good treatment response was defined as no sub- and intra-retinal fluid on OCT. Multilevel logistic regression models accounting for the inclusion of two eyes of some participants were used to investigate predictive factors associated with treatment response.

Results : A total 139 eyes of 108 patients with treatment-naïve exudative AMD were included. Seventy-one patients (65.7%) were female, and 57 patients (52.8%) had family history of AMD. Most patients were treated with aflibercept (n=57, 41.0%), followed by bevacizumab (n=42, 30.2%) and ranibizumab (n=40, 28.8%). Based on the defined criteria, 53 eyes (38.1%) showed good response after 3 loading injections. Fifteen eyes (35.7%) of bevacizumab-treated eyes, 18 eyes (45.0%) of ranibizumab-treated eyes, and 20 eyes (35.1%) of aflibercept-treated eyes showed treatment response (P=0.873). Among the baseline characteristics assessed, female sex (OR=0.2, P=0.043) and presence of large PED (OR=0.1, P=0.013) were significantly associated with treatment response.

Conclusions : Nearly 38% of treatment-naïve exudative AMD patients showed complete resolution of subretinal and/or intraretinal fluid and hemorrhage after 3-loading intravitreal anti-VEGF injections. Female sex and large PED at baseline OCT were negative predictive factors for treatment response in this population.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.