To summarize the findings of long-term outcomes of anti-vascular endothelial growth factor (VEGF) therapy (≥36 months) in patients with exudative age-related macular degeneration.
Studies reporting long-term outcomes (≥36 months) of anti-VEGF therapy (n = 11) were identified and analyzed for changes in visual acuity (VA), optical coherence tomography, and safety findings.
Six prospective extension studies of Phase 3 clinical trials and five retrospective evaluation studies were identified. The largest improvements in VA with anti-VEGF treatment were found in Years 1 to 2 after treatment initiation. In five studies, VA ultimately declined below patients' pretreatment initial baseline; in three studies, VA ultimately returned to patients' baseline; in three studies, VA decreased but ultimately remained improved over patients' baseline. There was a trend demonstrating that a higher frequency of intravitreous injections showed a better maintenance in VA. Rates of adverse events were similar to previous registration studies of anti-VEGF drugs.
The body of evidence to date regarding long-term anti-VEGF treatment indicates a variable course at greater than 36 months follow-up and seems to be dependent on the treatment protocol. Consistent dosing with fluid-free interval is suggested to maintain VA gains in patients with exudative age-related macular degeneration. There is no evidence suggesting that there are additional adverse events from long-term anti-VEGF use.
Based on data from extension studies of Phase 3 clinical trials and retrospective studies greater than 36 months, patients with exudative age-related macular degeneration treated with intravitreous injections of anti-vascular endothelial growth factor agents for 3 or more years have a variable course dependent on the treatment protocol used.
*Case Western Reserve University School of Medicine, Cleveland, Ohio; and
†Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
Reprint requests: Rishi P. Singh, MD, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk i32, Cleveland, OH 44195; e-mail: SINGHR@ccf.org
R. P. Singh: Thrombogenics (consultant), Alcon (consultant, research grant), Regeneron (consultant, research grant); Shire (consultant), Genentech (consultant, research grant). The remaining authors have no financial/conflicting interests to disclose.