A new study in JAMA Ophthalmology found at least some patients with wet age-related macular degeneration (AMD) may be able to retain good vision years after stopping treatment, which could indicate not all people with this condition will need to be treated indefinitely. The investigation found 6.4% of its participants retained a visual acuity letter score of 68 (Snellen 20/40) or better after stopping anti-vascular endothelial growth factor treatments for at least three years.
A team of US researchers analyzed the results of the landmark CATT trial that made headlines a decade ago for validating the comparable efficacies of bevacizumab and ranibizumab. CATT studied injection patterns and visual acuity trends among 635 eyes with wet AMD from 43 US clinical centers during 2008 to 2009. In CATT, patients were randomized into one of four treatment groups: ranibizumab monthly, bevacizumab monthly, ranibizumab as needed or bevacizumab as needed. At one year, participants in the monthly groups either continued treatment or were switched to as-needed with the same drug they were originally assigned. At year two, participants stopped treatment at the discretion of their ophthalmologist, and patients were followed up again at five years.
The current post-hoc analysis of CATT data, conducted from 2018-2019, compared the eyes of 40 participants who stopped treatment and still had good visual acuity (known as the “cessation of treatment with good visual acuity group”) with the remaining 585 eyes from the CATT follow-up study.
Baseline characteristics were similar between the groups, except for a better VA letter score in the study eye (68.8 vs. 61.8) and the fellow eye (78.4 vs. 68) in addition to more blocked fluorescence in the patients who stopped treatment but still had good vision compared to the other group (27.5% and 13.8%, respectively).
Of note: the cessation of treatment with good visual acuity with as-needed treatment group received fewer injections in year one (5.8 vs. 8.1) and year two (7.7 vs. 13.8) compared to eyes in the other as-needed group. The approximate VA letter score at five years was 79 (Snellen 20/25) in the cessation of treatment with good visual acuity group and 57.5 (Snellen 20/80) in the other group.
These findings suggest that a small proportion of eyes with neovascular AMD can retain good visual acuity with no treatment for at least three years after the initial two years of treatment, the study noted.
“Unique characteristics of eyes that could discontinue treatment while maintaining good visual acuity could not be identified at baseline, but data suggest that not all eyes with this disease may need treatment forever,” researchers wrote.
|Scoles D, Ying GS, Pan W, et al. Characteristics of eyes with good visual acuity at five years after initiation of treatment for age-related macular degeneration but not receiving rreatment from years three to five: Post hoc analysis of the CATT randomized clinical trial. JAMA Ophthalmol. Jan. 30, 2020 [Epub ahead of print].|