Researchers who conducted the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) trial recently revisited their patients a year after the trial concluded and found reason to be concerned. The initial trial recorded outcomes of patients with central retinal vein occlusion (CRVO) or hemiretinal vein occlusion (HRVO) one year after they completed the trial treatment schedule, and found visual acuity letter score and central subfield thickness improvement from baseline to month 12; however, they subsequently worsened from month 12 to 24 in both groups, with no differences between aflibercept or bevacizumab treatment groups.
Among 362 of the trial’s participants, 65.2% completed a visit two years after the trial ended. The mean visual acuity letter score improved from baseline to 12 months by 21.6 in the aflibercept group compared with 21.9 in the bevacizumab group, then worsened from those values by 7.6 in the aflibercept group and 7.5 in the bevacizumab group at month 24. The central subfield thickness improved from baseline to 12 months by 394μm in the aflibercept group and 420μm in the bevacizumab group, then by 58μm in the aflibercept group and 48μm in the bevacizumab group at month 24. Poorer anatomic outcomes associated with bevacizumab compared with aflibercept during the first six months of the study did not translate into poorer visual acuity or anatomic outcomes after two years.
The analysis suggests that CRVO and HRVO warrant close monitoring and treatment as needed for at least two years to maintain favorable outcomes in eyes treated with anti-VEGF therapy. However, the researchers do note that the follow-up of only two-thirds of the study’s participants at month 24 limits confidence in these results.
|Scott IU, Oden NL, VanVeldhuisin PC, et al. Month 24 outcomes after treatment initiation with anti–vascular endothelial growth factor therapy for macular edema due to central retinal or hemiretinal vein occlusion SCORE2 Report 10: a secondary analysis of the SCORE2 randomized clinical trial. JAMA Ophthalmol. October 10, 2019. [Epub ahead of print].|