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Risk for low visual acuity after 1 and 2 years of treatment with anti-VEGF. Comparison of different agents: Ranibizumab, Aflibercept, and Bevacizumab
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
2018 (English)In: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 59, no 9Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Purpose : To analyze the risk factors for low visual acuity and compare the visual acuity, number of visits and injections received by patients on different anti-vascular endothelial growth factor (anti-VEGF) therapies after one and two years of treatment.

Methods : Retrospective register-based cohort study from the national Swedish Macula Register (SMR). Treatment naïve eyes and treated exclusively with ranibizumab, bevacizumab or aflibercept, followed for two years. Evaluation of baseline characteristics as age, best corrected visual acuity (BCVA) and type of lesion and treatment drug. The risks of low visual acuity (BCVA ≤60 ETDRS letters) during the first and second year were estimated.

Results : Mean BCVA were 56.2, 62 and 62.5 ETDRS letters for baseline, year 1 and year 2 respectively. Aflibercept eyes received 5.9 injections year one and 3.9 year two. Bevacizumab and ranibizumab treated eyes received 5.3 and 4.7 injections year one and 3.8 and 3.1 injections year two respectively. The average number of vists in the ranibizumab and bevazicumab groups was slightly higher compared to aflibercept group both year 1 and 2. VA improved on average in all treatment groups. At year one 33% of eyes in Aflibercept and Bevacizumab and 34% in Ranibizumab treated group had a VA of less than 60 ETDRS letters. Number of eyes discontiuning treatment or lost to follow-up after two years were 55% (2016/3678). Low visual acuity were the main reason for discontinuation. Older patients and low baseline VA were risk factors for low VA after one and two years of treatment.

Conclusions : This study show a shift in treatment regimen in Sweden 2013 with increasing number of injections and an inclination to follow label with fewer visits and more injections instead of PRN (Pro re nata) regimen. Maintenance in mean VA after one and two years is seen in all treatment groups but eyes treated with aflibercept show a slightly better mean VA after one and two years. However, it is worth noticing that those patients have on average a better baseline VA. Treatment are also maintained in a higher degree for aflibercept treated eyes. Risk factors for low visual acuity after one and two years of treatment are, as expected, older patients and low baseline VA.

Place, publisher, year, edition, pages
The Association for Research in Vision and Ophthalmology, Inc. , 2018. Vol. 59, no 9
National Category
Ophthalmology
Identifiers
URN: urn:nbn:se:umu:diva-152277ISI: 000442912502101OAI: oai:DiVA.org:umu-152277DiVA, id: diva2:1252577
Conference
Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology (ARVO), APR 29-MAY 03, 2018, Honolulu, HI
Available from: 2018-10-02 Created: 2018-10-02 Last updated: 2018-10-02Bibliographically approved

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