Disease Recurrence Common, But Unpredictable in Neovascular AMD

When patients with neovascular age-related macular degeneration (nAMD) are deemed  stable, treatments with anti-vascular endothelial growth factor (VEGF) injections are suspended. However, a study published in Ophthalmology Retina now shows that recurrence in these patients is common.

The prospective cohort study was conducted with 105 nAMD patients who previously received a treat-and-extend regimen with aflibercept injections and had a dry macula on 3 consecutive visits, 12 weeks apart. Examinations in the study happened at baseline, and then patients were monitored for disease recurrence 4, 6, 8, 10 and 12 months after their last injection. The main outcome measures were how many patients had recurrent disease by 12 months after their last injection and change in best-corrected visual acuity (BCVA) at time of recurrence and after resumed therapy.

Researchers found evidence of recurrent nAMD in 54/102 patients (52.9%) after 12 months of follow-up, with the mean time to recurrence after the last injection at 6.7±2.2 months. The BCVA decreased from 71.7±10.0 ETDRS letters at baseline to 68.1±11.1 letters at recurrence (P =.12), but after treatment was restarted, increased to 71.4±10.0 letters (P =NS compared with baseline). 

“Patients with a pigment epithelial detachment (PED) at baseline had a 74% (14/19) recurrence rate compared [with] 48% (40/83) in [patients] without a PED (P <.05). Only 22/54 (40.7%) of the patients with recurrent disease had symptoms of visual loss or metamorphopsia,” according to the research.

The study cohort’s relatively small size could be a potential limitation in the study, investigators say. “Some potential risk factors for reactivation like previous recurrence of nAMD and absence of [geographic atrophy] did not fully meet statistical significance. It is possible that the study did not have the power to expose these outcomes and that a larger sample size could have affected these results.”

Disclosure: Some study authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.  

Reference

Aslanis S, Amrén U, Lindberg C, Epstein D. Recurrent neovascular age-related macular degeneration after discontinuation of VEGF inhibitors managed in a treat and extend regimen. Ophthalmol Retina. Published online March 25, 2021. doi:10.1016/j.oret.2021.03.010.