Intravitreal Ranibizumab in Daily Clinical Practice for Age-Related Macular Degeneration: Treatment of Exudative Age-Related Macular Degeneration in Real Life

Abstract

Purpose: To describe the anatomical and functional outcomes in patients with exudative age-related macular degeneration (AMD) undergoing ranibizumab therapy in real-life practice. Methods: This is a retrospective analysis of patients with exudative AMD treated with ranibizumab. Visual acuity (VA) and optic coherence tomography characteristics at baseline and at the end of the follow-up, clinical forms of the disease, delay between diagnosis and treatment as well as the number of follow-up visits and of intravitreal injections were collected. Results: One hundred and seventy-nine patients (220 eyes) were followed up during a mean of 24 months. The mean delay between diagnosis and treatment was 20.3 days (SD ±16.8). VA stabilization was observed in 46.4% of eyes, 21.7% of eyes gained ≥15 ETDRS (Early Treatment Diabetic Retinopathy Study) letters and 31.9% lost ≥15 ETDRS letters. The mean central retinal thickness decreased from 380.6 μm at baseline to 295.6 µm at the final examination. A lower baseline VA score was associated with a greater gain of letters (OR 1.04, 95% CI 1.02-1.06; p < 0.001). Conclusion: Shortening the delays in diagnosis appears to be a key point in real-life situations.

Baseline visual acuity as a prognostic factor for visual outcomes in patients treated with aflibercept for wet age‐related macular degeneration: data from the INSIGHT study using the Swedish Macula Register

“…We observed that patients with the lowest baseline VA also had the most pronounced gain in VA, a finding described previously by others (Cazet‐Supervielle et al. ; Gillies et al. ).…”

The role of indocyanine green angiography imaging in further differential diagnosis of patients with nAMD who are morphologically poor responders to ranibizumab in a real-life setting

“…Several studies have been conducted in this important topic and the terminology for anti-VEGF treatment response has been defined in detail. 15,16,25 The response to anti-VEGF agents has been categorized either as functional or morphological response. 15 Amoaku et al 15 have recently proposed to classify patients with nAMD into four categories with regard to their functional response based on the change in VA, which were as follows, good responders (45 ETDRS letter gain from the baseline), suboptimal responders (gain of 0-5 letters from Figure 3 The simultaneous fluorescein and indocyanine green angiography images of a 71-year-old female retinal angiomatous proliferation patient.…”

“…15,16,26 Factors affecting drug pharmacodynamics and pharmacokinetics such as receptor downregulation, autoantibody formation, change in drug distribution, and absorption have also been shown to be related to nonresponse. 15,25,26 Suboptimal treatment of the patients with less frequent treatment regimens is another important clinical factor which can affect the treatment success and underlie nonresponse. Real-life studies showed that many of the patients were undertreated especially in the PRN treatment regimens.…”

“…Real-life studies showed that many of the patients were undertreated especially in the PRN treatment regimens. 25 Also disease chronicity, change of cytokine profile during the treatment, and chronic inflammation were shown to be important clinical factors. 15,26 It is worth to recall here that some lesion types of nAMD are less responsive to anti-VEGF treatment.…”

Characteristics and Predictors of Early and Delayed Responders to Ranibizumab Treatment in Neovascular Age-Related Macular Degeneration: A Retrospective Analysis from the ANCHOR, MARINA, HARBOR, and CATT Trials

“…For ranibizumab, one trial showed that only 6% of subjects typically require monthly dosing, while the remainder can be treated less frequently using an individualized approach [10] . Thus, real-life treatment of nAMD is typically individualized for most subjects following initial monthly treatment [11][12][13] , with clear benefits seen with early treatment [14] . Indeed, individualized dosing is recommended in the prescribing information for ranibizumab and the intervals between doses can be extended according to the treating physician's opinion and an assessment of disease severity [11] .…”