Most wet AMD patients who haven’t been treated previously may regain vision at a slower rate after initial anti-VEGF therapy, but this early response may result in better long-term vision outcomes by 24 months of treatment, a new study in Ophthalmology Retina reports.

These findings suggest continued treatment may result in greater vision improvements when consistent anti-VEGF therapy is maintained over a longer period of time, the research team from California suggests.

The study was a secondary analysis of the HARBOR trial and looked at whether peak best-corrected visual acuity (BCVA) could predict changes in BCVA by the study’s end.

The participants were treatment naïve, aged 50 or older and had subfoveal neovascular AMD. The study pooled data by anti-VEGF (Lucentis, Genentech) dose and separately evaluated data by dosing schedule, either dosing as needed or monthly.

The study defined “time to peak” BCVA as the monthly evaluation at which the patient’s greatest gain in Early Treatment Diabetic Retinopathy Study (ETDRS) letters was achieved from baseline.

“Early peakers” had peak BCVA between day seven and six months. “Late peakers” achieved peak BCVA between months seven, 12, 13, 18, 19 and 24. The researchers considered several variables including baseline demographic/clinical characteristics, presence of persistent subretinal fluid or intraretinal fluid and “on-study” events such as atrophy status, fibrosis and retinal pigment epithelium tears.

Most patients reached peak BCVA after more than six months of treatment: 64% in the as-needed dosing group (301/474) and 70% in the monthly group (327/469). Additionally, 36% of the as-needed dosing group and 30% of the monthly dosing patients peaked early, while 64% and 70%, respectively, peaked late.

At month 24, early peakers, on average, lost vision (as-needed dosing: −1.6 ETDRS letters, monthly dosers: −1.9 ETDRS letters). By contrast, late peakers had significantly better vision gains from baseline (as-needed dosers: 8.5 to 17.7 ETDRS letters, monthly dosers: 10.1 to 18.7 ETDRS letters).

The study found no differences in patient characteristics, persistent subretinal fluid/intraretinal fluid or on-study events that accounted for the different outcomes between early vs. late peakers.

Khurana RN, Chang L, Day B, et al. Timing of peak vision gains in patients with neovascular age-related macular degeneration treated with ranibizumab. Ophthalmology Retina. February 27, 2020. [Epub ahead of print].