Long-term monitoring and treatment with anti-VEGF therapy improves vision in patients with retinal vein occlusion (RVO), researchers have confirmed.1 The results, from the SCORE2 study, indicate that anti-VEGF therapy was associated with a significant improvement in visual acuity (VA) for up to five years in patients with macular edema due to central retinal or hemiretinal vein occlusion (CRVO; HRVO).
“Prior to this study, retinal vein occlusion was considered to be an acute illness. However, our findings suggest that macular edema associated with RVO is a chronic disease that warrants continued monitoring and individualized treatment to optimize visual outcomes of anti-VEGF therapy,” said Ingrid Scott, MD, MPH, at Penn State College of Medicine in Hershey, Pennsylvania. Dr. Scott is the principal investigator and chair of SCORE2 (Study of Comparative Treatments for Retinal Vein Occlusion 2).
CRVO. This image of a SCORE2 participant with CRVO shows extensive retinal hemorrhage and dilated retinal veins.
Study overview. In 2017, the SCORE2 investigators published results indicating that bevacizumab (Avastin) and aflibercept (Eylea) provide similar benefits in terms of VA at six months in patients with macular edema associated with CRVO or HRVO.2
Initially, 362 eyes were enrolled, with 180 study eyes receiving aflibercept and 182 receiving bevacizumab. Of these, 330 eyes were followed through month 12 and eligible to be enrolled in the long-term analysis.1 At this point, participants were treated per investigator discretion, using any commercially available drug (including nonstudy anti-VEGF or no drug). In addition, after the initial year, participants were evaluated annually for VA letter score and central subfield thickness (CST) for four years.
Five-year outcomes. Overall mean improvement in VA letter score from baseline among patients completing the month 60 visit was 13.5 (95% confidence interval [CI], 9.6-17.5), with no significant differences between patients initially treated with bevacizumab and those initially treated with aflibercept. The five-year improvement in letter score was lower than the mean improvement observed at month 12 (20.6; 95% CI, 18.7-22.4). CST also improved, from a mean of 671 μm at baseline to 261 μm at month 60.
However, as Dr. Scott noted, only 45% of eligible participants completed the month 60 visit. “One of the biggest challenges in conducting long-term studies is participant retention.”
An unexpected finding. “Interestingly, only 24% of patients had complete resolution of macular edema at month 60,” Dr. Scott said. More than 65% of completers received at least one anti-VEGF injection between months 48 and 60, with a mean of 3.41 treatments received during this 12-month period, she added. “These findings suggest that monitoring and individualized treatment with anti-VEGF therapy are warranted to optimize visual outcomes in patients with macular edema associated with CRVO or HRVO.”
Dr. Scott also noted that the fact that treatment was per investigator discretion after month 12 resulted in considerable heterogeneity with respect to treatment regimens. “This limited our ability to make comparisons between originally assigned treatment arms but provides useful information about real-world clinical practice and outcomes.”
Next steps. Future plans include detailed imaging studies to investigate for imaging biomarkers associated with visual and anatomic outcomes in patients treated with anti-VEGF therapy, Dr. Scott said. The investigators also are planning genetic analyses to identify genetic markers of response to treatment.
—Christos Evangelou, PhD
1 Scott IU et al., for the SCORE2 Investigator Group. Am J Ophthalmol. 2022;240:330-341.
2 Scott IU et al., for the SCORE2 Investigator Group. JAMA. 2017;317(20):2072-2087.
Relevant financial disclosures: Dr Scott—NEI: S.
For full disclosures and the disclosure key, see below.
Full Financial Disclosures
Dr. Bellsmith NIH: S; Research to Prevent Blindness: S.
Dr. Galor AstraZeneca: C; Dompé: C; Eye Cool: C; Novartis: C; Ocular Therapeutix: C; Tarsus: C.
Dr. Scott Allergan: S; NEI: S; Regeneron: C,S.
Dr. Thomas NIH: S; Research to Prevent Blindness: S.
Dr. Yam None.
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