Real-World Data Show Suboptimal Response to Anti-VEGF Agents in Macular Edema

Kelly Davio

Retinal vein occlusion (RVO) is a prevalent, vision-threatening disease, of which macular edema is a common complication. Standard treatment for RVO-associated macular edema involves intravitreal treatment with anti–vascular endothelial growth factor (anti-VEGF) agents such as ranibizumab, bevacizumab, or aflibercept. Despite success with these agents in clinical trials, anti-VEGF agents may be administered less frequently in clinical practice than in studies.

Retinal vein occlusion (RVO) is a prevalent, vision-threatening disease, of which macular edema is a common complication. Standard treatment for RVO-associated macular edema involves intravitreal treatment with anti—vascular endothelial growth factor (anti-VEGF) agents such as ranibizumab, bevacizumab, or aflibercept. Despite success with these agents in clinical trials, anti-VEGF agents may be administered less frequently in clinical practice than in studies.

Researchers sought to evaluate the efficacy, safety, and injection frequency of anti-VEGF drugs in treating macular edema secondary to RVO in clinical practice, and used a multicenter, retrospective, open-label chart review of 165 patients 18 years and older who received at least 3 intravitreal injections of anti-VEGF from August 2013 to September 2014.

A total of 117 patients had 1 year or more of follow-up after anti-VEGF treatment, and 40 (24.2%) continued to receive anti-VEGF injections and had data available through year 2. Seventeen (10.3%) continued therapy and had data available through year 3.

A total of 1641 anti-VEGF injections were administered, 842 (51.3%) of which were ranibizumab, 724 (41.1%) of which were bevacizumab, and 75 (4.6%) of which were aflibercept. Most patients received repeated injections of 1 agent, but 33.3% (n = 55) of patients switched agents at least 1 time during the study period.

In controlled clinical trials conducted for its approval, ranibizumab was administered monthly for 6 months and as needed through 1 year. By contrast, in this study, patients received a mean of 7.1 (range, 1-15) anti-VEGF injections in year 1, 5.4 (range, 1-13) in year 2, and 5.9 (range, 1-11) in year 3. The mean interval between injections ranged from 1.1 to 1.6 months across the first 16 injections.

The primary end point of combined visual and anatomic response (measured as best-corrected visual acuity of 20/40 or better and central retinal thickness of 250 mcm or less on time-domain optical coherence tomography or 300 mcm or less on spectral-domain optical coherence tomography at the same visit) was achieved by just 20.0% to 36.7% of patients after the first 16 injections.

“In this real-world study, a mean of [5] to [7] anti-VEGF injections was administered yearly, and the response to anti-VEGF therapy was suboptimal in many patients,” write the authors. “More frequent injections may improve outcomes, but some patients do not achieve a dry macula even with monthly injections.”

Reference

Jumper JM, Dugel PU, Chen S, Blinder KJ, Walt JG. Anti-VEGF treatment of macular edema associated with retinal vein occlusion: patterns of use and effectiveness in clinical practice (ECHO study report 2). Clin Ophtalmol. 2018;12:621-629. doi: 10.2147/OPTH.S163859.