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  • U.S. Experience: Real-World Outcomes in Wet AMD

    By Jean Shaw
    Selected By: Andrew P. Schachat, MD
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    Journal Highlights

    Ophthalmology Retina, July 2018

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    Ciulla et al. set out to assess the out­comes of “real-world” U.S. patients who receive intravitreal injections for neo­vascular age-related macular degenera­tion (AMD). They also sought to assess the impact that loss to follow-up has on visual outcomes. They found that—as previously noted in studies conducted outside the United States—patients treated with anti–vascular endothelial growth factor (anti-VEGF) agents in clinical practice receive fewer injections and have worse visual outcomes than do those treated according to a strict protocol in a randomized clinical trial.

    For this retrospective study, the researchers evaluated electronic health records from a geographically and demographically diverse sample of patients treated by U.S. retina special­ists. At the time of the analysis (January 2011 to July 2013), there were 77,985 patients with neovascular AMD in the database; after inclusion criteria were applied, records of 2,213 treatment-naive patients were evaluated.

    The researchers divided the patients into 3 mutually exclusive cohorts, depending on whether they were considered lost to follow-up after 6, 12, or 24 months of treatment. Overall, anti-VEGF use by agent was 13% for afliber­cept, 17% for ranibizumab, and 70% for bevacizumab; the 6-month cohort had a higher percentage of aflibercept use (20%), while 15% received ranibi­zumab, and 65% received bevacizumab.

    Patients in the 6-month cohort re­ceived a mean of 5.4 injections, versus 7.3 and 12.1 injections, respectively, in the 12-and 24-month cohorts. No change in VA from baseline was noted in either the 6-or 12-month cohort; in contrast, patients in the 24-month cohort experienced a net gain of 3.1 let­ters. Individual patients with better VA at presentation tended to be particular­ly vulnerable to vision loss. In addition, patients lost to follow-up tended to have poorer VA at their final visit, the researchers noted.

    Taken together, these real-world outcomes highlight an unmet need for better treatment of neovascular AMD, the researchers said.

    The original article can be found here.