Abstract
Purpose
To analyze choroidal neovasularization (CNV) activity and recurrence patterns in patients with neovascular age-related macular degeneration (nAMD) treated with ranibizumab, and the correlation with individual intraocular vascular endothelial growth factor (VEGF) suppression time (VST).
Methods
Post-hoc analysis of data from a prospective, non-randomized clinical study. Patients with nAMD treated with ranibizumab on a pro re nata regimen. Disease activity was analyzed monthly by spectral-domain optical coherence tomography and correlated with VSTs.
Results
Overall, 73 eyes of 73 patients were included in the study with a mean follow-up of 717 days (range: 412–1239 days). Overall, the mean CNV-activity-free interval was 76.5 days (range: 0–829 days). The individual range of the length of dry intervals was high. A total of 42% of patients had a range of more than 90 days. Overall, 16% of patients showed persistent activity. And 12% stayed dry after the initial ranibizumab treatment. No significant correlation was found between the CNV-recurrence pattern and VST (P=0.12).
Conclusions
CNV activity in nAMD is irregular, which is reflected in the range of the duration of dry intervals and late recurrences. The biomarker VST solely seems not to be sufficient to explain recurrence pattern of CNV in all AMD patients.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Solomon SD, Lindsley K, Vedula SS, Krzystolik MG, Hawkins BS . Anti-vascular endothelial growth factor for neovascular age-related macular degeneration. Cochrane Database Syst Rev 2014; 8: CD005139.
Muether PS, Hermann MM, Koch K, Fauser S . Delay between medical indication to anti-VEGF treatment in age-related macular degeneration can result in a loss of visual acuity. Graefes Arch Clin Exp Ophthalmol 2011; 249 (5): 633–637.
Muether PS, Hoerster R, Hermann MM, Kirchhof B, Fauser S . Long-term effects of ranibizumab treatment delay in neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2013; 251 (2): 453–458.
Kiss S, Liu Y, Brown J, Holekamp NM, Almony A, Campbell J et al. Clinical monitoring of patients with age-related macular degeneration treated with intravitreal bevacizumab or ranibizumab. Ophthalmic Surg Lasers Imaging Retina 2014; 45 (4): 285–291.
Ziemssen F, Eter N, Fauser S, Bopp S, Radermacher M, Hasanbasic Z et al. Retrospective investigation of anti-VEGF treatment reality and effectiveness in patients with neovascular age-related macular degeneration (AMD) in Germany: treatment reality of ranibizumab for neovascular AMD in Germany. Ophthalmologe 2015; 112 (3): 246–254.
Haller JA . Current anti-vascular endothelial growth factor dosing regimens: benefits and burden. Ophthalmology 2013; 120 (5 Suppl): S3–S7.
Rayess N, Houston SK 3rd, Gupta OP, Ho AC, Regillo CD . Treatment outcomes after 3 years in neovascular age-related macular degeneration using a treat-and-extend regimen. Am J Ophthalmol 2015; 159 (1): 3–8 e1.
Berg K, Pedersen TR, Sandvik L, Bragadottir R . Comparison of ranibizumab and bevacizumab for neovascular age-related macular degeneration according to LUCAS treat-and-extend protocol. Ophthalmology 2015; 122 (1): 146–152.
Muether PS, Hermann MM, Viebahn U, Kirchhof B, Fauser S . Vascular endothelial growth factor in patients with exudative age-related macular degeneration treated with ranibizumab. Ophthalmology 2012; 119 (10): 2082–2086.
Muether PS, Hermann MM, Droge K, Kirchhof B, Fauser S . Long-term stability of vascular endothelial growth factor suppression time under ranibizumab treatment in age-related macular degeneration. Am J Ophthalmol 2013; 156 (5): 989–993 e982.
Mantel I, Deli A, Iglesias K, Ambresin A . Prospective study evaluating the predictability of need for retreatment with intravitreal ranibizumab for age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2013; 251 (3): 697–704.
Aiello LP, Avery R, Arrigg P, Keyt B, Jampel H, Shah S et al. Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med 1994; 331: 1480–1487.
Funatsu H, Yamashita H, Noma H, Mimura T, Nakamura S, Sakata K et al. Aqueous humor levels of cytokines are related to vitreous levels and progression of diabetic retinopathy in diabetic patients. Graefes Arch Clin Exp Ophthalmol 2005; 243: 3–8.
Noma H, Funatsu H, Mimura T, Harino S, Hori S . Aqueous humor levels of vasoactive molecules correlate with vitreous levels and macular edema in central vein occlusion. Eur J Ophthalmol 2010; 20: 402–409.
Ecker SM, Hines JC, Pfahler SM, Glaser BM . Aqueous cytokine and growth factor levels do not reliably reflect those levels found in the vitreous. Mol Vis 2011; 17: 2856–2863.
Acknowledgements
This study was supported by a grant from the Novartis. The sponsor had no role in design, conduct, or analysis of the study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Enders, P., Scholz, P., Muether, P. et al. Variability of disease activity in patients treated with ranibizumab for neovascular age-related macular degeneration. Eye 30, 1072–1076 (2016). https://doi.org/10.1038/eye.2016.97
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/eye.2016.97
