Author: Jordi Izquierdo-Serra
Co-authors: Ruben Martin-Pinardel, Alba Parrado-Carrillo, Aina Moll-Udina, Carolina Bernal-Morales, Martin Puzo, Carolina Arruabarrena, Ana Fernandez-Hortelano, Marta S.Figueroa, Maximino Abraldes, Gonzaga Garay-Aramburu, Francisco Javier Lavid de los Mozos, Miguel Angel Zapata, Jose Maria Ruiz-Moreno, Laura Broc-Iturralde, Jacobo Gonzalez-Guijarro, Jose Juan Escobar-Barranco, Roberto Gallego-Pinazo, Ricardo P. Casaroli-Marano, Javier Zarranz-Ventura
Abstract
Purpose:To evaluate the influence of neovascular lesion phenotype on 12 and 24 months clinical outcomes in age-related macular degeneration (nAMD) eyes treated with anti-vascular endothelial growth factor (VEGF) drugs nationwide.
Setting/Venue:
Multicenter national nAMD database observational study.
Methods:
Neovascular nAMD eyes were treated with fixed bimonthly (FB) or treat-and-extend (TAE) regimens. Data were collected using an international consortium health outcome measurement (ICHOM)-compliant validated web-based tool (Fight Retinal Blindness! Project AMD module). The minimum data set included: demographics, visual acuity (VA) in logarithm of the minimum angle of resolution (logMAR) ETDRS letters at baseline and in all subsequent visits, number of injections and visits. Neovascular lesion phenotype was classified according to the international classification, and baseline and final VA, VA change at 12 and 24 months, number of injections, drug type, visits and active visits were evaluated.
Results:
A total number of 1606 eyes of 1330 nAMD patients receiving anti-VEGF intravitreal injections in 28 centers were collected. Mean (±standard deviation) baseline VA in the overall, type 1, type 2, type 3 and IPCV cohorts was 55.0 (±21.8), 57.8.2 (±20.8), 49.4 (±23.5), 58.2 (±19.4) and 53.4 (±21.6) respectively, with significant differences between lesion types (p<0.05: Type 1 vs Type 2; Type 1 vs IPCV; Type 2 vs Type 3; Type 3 vs IPCV). Mean VA change at 12/24 months was +4.1/+1.4 letters in the overall cohort, +4.1/+1.9 letters in type 1, +4.0/+1.0 letters in type 2, +3.1/+1.7 letters in type 3 and +9.5/-3.5 letters in IPCV, with greater differences between certain lesion types (p<0.05 Type 3 vs IPCV). The percentage of ≥15 letters losers/gainers at 24 months was 16.7%/20.7% overall, 14.6%/19.0% in type 1, 20.7%/23.4% in type 2, 15.4%/22.0% in type 3 and 20.0%/16.7% in IPCV, with no significant differences between lesion types. The median number of injections at 12/24 months was 7/11 overall, with no differences between lesion types at any of both timepoints. Type 3 lesions presented lower percentage of active visits than the other lesion types. Study drugs included ranibizumab (45.3%), aflibercept (39.1%) and bevacizumab (15.6%).
Conclusions:
This study highlights the relevance of neovascular lesion phenotype on clinical outcomes in nAMD, and reports significant differences in baseline VA, VA change and lesion activity, described by the number of visits with active lesions. This report provides clinicians relevant data about lesion-specific clinical features, which may guide the management of nAMD cases and potentially provide predictive data to support the clinical decision making in routine clinical care, towards a personalized management of nAMD cases.
