Five-Year Outcomes with Anti-Vascular Endothelial Growth Factor Treatment of Neovascular Age-Related Macular Degeneration: The Comparison of Age-Related Macular Degeneration Treatments Trials

Maureen G Maguire; Daniel F Martin; Gui-Shuang Ying; Glenn J Jaffe; Ebenezer Daniel; Juan E Grunwald; Cynthia A Toth; Frederick L Ferris III; Stuart L Fine; Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group

doi:10.1016/j.ophtha.2016.03.045

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Five-Year Outcomes with Anti-Vascular Endothelial Growth Factor Treatment of Neovascular Age-Related Macular Degeneration: The Comparison of Age-Related Macular Degeneration Treatments Trials

Journal article

Open access

Peer reviewed

Five-Year Outcomes with Anti-Vascular Endothelial Growth Factor Treatment of Neovascular Age-Related Macular Degeneration: The Comparison of Age-Related Macular Degeneration Treatments Trials

Maureen G Maguire, Daniel F Martin, Gui-Shuang Ying, Glenn J Jaffe, Ebenezer Daniel, Juan E Grunwald, Cynthia A Toth, Frederick L Ferris III, Stuart L Fine and Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group

Ophthalmology (Rochester, Minn.), Vol.123(8), pp.1751-1761

08/2016

DOI: 10.1016/j.ophtha.2016.03.045

PMCID: PMC4958614

PMID: 27156698

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Abstract

To describe outcomes 5 years after initiating treatment with bevacizumab or ranibizumab for neovascular age-related macular degeneration (AMD). Cohort study. Patients enrolled in the Comparison of AMD Treatments Trials. Patients were assigned randomly to ranibizumab or bevacizumab and to 1 of 3 dosing regimens. After 2 years, patients were released from the clinical trial protocol. At 5 years, patients were recalled for examination. Visual acuity (VA) and morphologic retinal features. Visual acuity was obtained for 647 of 914 (71%) living patients with average follow-up of 5.5 years. The mean number of examinations for AMD care after the clinical trial ended was 25.3, and the mean number of treatments was 15.4. Most patients (60%) were treated 1 time or more with a drug other than their assigned drug. At the 5-year visit, 50% of eyes had VA of 20/40 or better and 20% had VA of 20/200 or worse. Mean change in VA was -3 letters from baseline and -11 letters from 2 years. Among 467 eyes with fluorescein angiography, mean total lesion area was 12.9 mm(2), a mean of 4.8 mm(2) larger than at 2 years. Geographic atrophy was present in 213 of 515 (41%) gradable eyes and was subfoveal in 85 eyes (17%). Among 555 eyes with spectral-domain optical coherence tomography, 83% had fluid (61% intraretinal, 38% subretinal, and 36% sub-retinal pigment epithelium). Mean foveal total thickness was 278 μm, a decrease of 182 μm from baseline and 20 μm from 2 years. The retina was abnormally thin (<120 μm) in 36% of eyes. Between 2 and 5 years, the group originally assigned to ranibizumab for 2 years lost more VA than the bevacizumab group (-4 letters; P = 0.008). Otherwise, there were no statistically significant differences in VA or morphologic outcomes between drug or regimen groups. Vision gains during the first 2 years were not maintained at 5 years. However, 50% of eyes had VA of 20/40 or better, confirming anti-vascular endothelial growth factor therapy as a major long-term therapeutic advance for neovascular AMD.

Bevacizumab - therapeutic use

Prospective Studies

Follow-Up Studies

Intravitreal Injections

Geographic Atrophy - diagnosis

Tomography, Optical Coherence

Humans

Male

Treatment Outcome

Wet Macular Degeneration - physiopathology

Ranibizumab - therapeutic use

Vascular Endothelial Growth Factor A - antagonists & inhibitors

Wet Macular Degeneration - diagnosis

Wet Macular Degeneration - drug therapy

Subretinal Fluid

Aged, 80 and over

Angiogenesis Inhibitors - therapeutic use

Female

Aged

Retina - pathology

Visual Acuity - physiology

Cohort Studies

Fluorescein Angiography

Details

Title: Subtitle: Five-Year Outcomes with Anti-Vascular Endothelial Growth Factor Treatment of Neovascular Age-Related Macular Degeneration: The Comparison of Age-Related Macular Degeneration Treatments Trials
Creators: Maureen G Maguire - Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: maguirem@mail.med.upenn.edu
Daniel F Martin - Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio
Gui-Shuang Ying - Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
Glenn J Jaffe - Department of Ophthalmology, Duke University, Durham, North Carolina
Ebenezer Daniel - Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
Juan E Grunwald - Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
Cynthia A Toth - Department of Ophthalmology, Duke University, Durham, North Carolina
Frederick L Ferris III - National Eye Institute, National Institutes of Health, Bethesda, Maryland
Stuart L Fine - Department of Ophthalmology, University of Colorado, Denver, Colorado
Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group
Contributors: James C Folk (Contributor) - University of Iowa, Ophthalmology and Visual Sciences
Douglas B Critser (Contributor) - University of Iowa, The University of Iowa Institute for Vision Research
Stephen R Russell (Contributor) - University of Iowa, Ophthalmology and Visual Sciences
Heather A Stockman (Contributor) - University of Iowa, Ophthalmology and Visual Sciences
Resource Type: Journal article
Publication Details: Ophthalmology (Rochester, Minn.), Vol.123(8), pp.1751-1761
DOI: 10.1016/j.ophtha.2016.03.045
PMID: 27156698
PMCID: PMC4958614
NLM abbreviation: Ophthalmology
ISSN: 0161-6420
eISSN: 1549-4713
Publisher: United States
Grant note: U10 EY017828 / NEI NIH HHS U10 EY017826 / NEI NIH HHS U10 EY017825 / NEI NIH HHS U10 EY017823 / NEI NIH HHS U10 EY023530 / NEI NIH HHS
Language: English
Date published: 08/2016
Academic Unit: The University of Iowa Institute for Vision Research; Ophthalmology and Visual Sciences
Record Identifier: 9983980092702771

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