Abstract
Purpose :
The efficacy of anti-VEGF drug injections differed in PCV patients, and the first-dose response affected patients' compliance. This study aimed to investigate whether the efficacy of the first injection can predict their third-dose response in 3+PRN regimen.
Methods :
This is a post-hoc analysis of a multi-centered, prospective, real-world observational study (START study). PCV patients treated with intravitreal injections of Conbercept using 3+PRN regimens with complete 3 monthly injection data were included. Good or poor first-dose response groups were divided based on whether the ratio of change in central macular thickness (CMT) (ΔCMT/baseline CMT) was smaller than -25%. Response correlations, risk factors associations, changes in CMT or best-corrected visual acuity (BCVA), and the number of injections in the first year, were evaluated.
Results :
A total of 181 eligible eyes were included. There was a significant correlation between good response to the first-dose vs. third-dose response (P<0.001), and 93.0% of eyes with good first-dose response maintained good anatomical improvement after the third injection, although the correlation was moderately strong (ICC=0.608, p<0.001). Patients with good first-dose response had higher baseline CMT, PED height, portion of intraretinal fluid (IRF) and smoking history (P<0.05), but not in terms of pachychoroid. Multivariate analysis revealed associations of good first-dose response with baseline CMT (OR=1.004, 95%CI 1.002-1.006, P<0.001), the presence of IRF (OR=2.060, 95%CI 1.025-4.137, P=0.042) with the predicted AUC of 0.793. CMT in the good first-dose response group showed a significant decrease from baseline in all the first-year follow-ups(p<0.001), and BCVA was improved significantly after the second injection. The good first-dose response group gained better VA improvement (8.4 ETDRS letters) than the poor response group (4.2 ETDRS letters) after the third injection. There is no significant difference between the two groups in the number of injections.
Conclusions :
First-dose responsiveness is of value for the anti-VEGF treatment of PCV. Patients with good first-dose response tend to have a better long-term response, but with no reductions in the follow-up times and anti-VEGF injections.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.