Measuring real-world visual acuity outcomes for ranibizumab and aflibercept in treatment of neovascular age-related macular degeneration (nAMD)

Abstract

Purpose : To develop and apply metrics to assess real-world visual outcomes throughout the treatment journey of patients treated with anti-vascular endothelial growth factor (anti-VEGF) therapy for nAMD.

Methods : This is a retrospective analysis of clinical data of patients currently undergoing intravitreal therapy for nAMD, treated by 11 retina specialists at 14 clinical sites in Australia following a treat and extend regimen, between January 1^st, 2000 and November 11^th, 2022. The choice of agent was at the discretion of the treating physician. Three visual metrics were assessed: Peak Visual Improvement (PVI) - difference between baseline VA and peak VA; Vision Loss from Peak (VLP) - difference between PVI and the most recent VA; Overall Visual Change (OVC) - difference between baseline and most recent VA. Snellen charts with pinhole were used for >90% of VA measurements. Visual metrics were compared between eyes treated with aflibercept and ranibizumab using a student t-test.

Results : Data from 3426 nAMD eyes of 2711 patients who were treated with only ranibizumab or only aflibercept were included in this analysis. Considering the entire cohort, over a mean of 2.78 years, the PVI was 7.74 letters (SD 9.59), the subsequent VLP was -11.46 (SD 14.00) yielding an OVC of -3.71 (SD 15.67).

For the whole period of the study, when comparing the 1097 patients (1370 eyes) who received ranibizumab and 1614 patients (2056 eyes) who received aflibercept, the latter had a better mean. Aflibercept was better than ranibizumab for PVI (8.09, SD 9.92 and 7.42, SD 8.94 letters, respectively; p=0.06) and VLP (-10.58, SD 12.77 and -12.8, SD 15.55 letters, respectively; p<0.001). OVC for aflibercept (-2.48 letters, SD 15.01) was better than ranibizumab (-5.38 letters, SD 16.62) (p<0.001) (Figure 1).
Analysis of these metrics within each of the first three years of treatment demonstrates differences between the two agents (Figure 2).

Conclusions : Long-term real world visual outcomes of anti-VEGF therapy for neovascular AMD are a few letters better for eyes treated with aflibercept than ranibizumab, as a result of greater peak visual improvement and lower subsequent vision loss from this peak.

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

 

Figure 1: Visual Metrics over whole period (error bars 95% CI)

 

Figure 2: Visual metrics over each of the first three years (***p<0.001)