Vision deteriorates moderately with long-term ranibizumab in most wet AMD patients

This retrospective study found that approximately two-thirds of wet AMD patients treated with a variable dosing regimen of ranibizumab required continuous monitoring and treatment for years.

The authors evaluated the four-year results of 855 wet AMD patients treated at a single center with a variable dosing regimen of ranibizumab. Good responders, approximately 21 percent of the group, who were able to discontinue treatment because of complete inactivation of choroidal neovascularization, and nonresponders, approximately 15 percent, were identified within the first two years of treatment. However, the remaining group of "regular" responders, approximately 64 percent of all patients, required continuous monitoring and treatment for years.

They say this is important information that should be given to patients at the initiation of treatment. In their experience, many patients prefer to know their prognosis-even though it may be grim-so that they can plan ahead, and therefore patients should be informed of the very protracted nature of treatment and that there is a certain level of unpredictability.

Patients included in the study were followed for a minimum of 15 months. After four years, 456 patients were still receiving active treatment and 399 patients had discontinued treatment. There was a significant decrease in vision from 53.2 to 50.5 letters (P < 0.001) after a mean follow-up of 23.3 months (range, 4 to 48 months).

Patients later judged to be untreatable had a worse BCVA compared with any of the other groups at baseline. The percentage of these patients able to recognize fewer than 20 letters improved from 10 at baseline to 48 after treatment. The authors say their results are somewhat comparable to those of most other studies using a PRN treatment strategy. However, no study has been as large with up to four years of follow-up, making direct comparisons difficult.