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Intravitreal Ranibizumab for neovascular Age-related macular degeneration in clinical practice: five-year treatment outcomes

  • Retinal Disorders
  • Published:
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Abstract

Background

Intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents are the established standard of care for neovascular age-related macular degeneration (nAMD). However, data on long-term outcomes of this therapy are limited. The purpose of this study was to assess the visual and anatomical outcomes and safety profile of intravitreal ranibizumab in treating nAMD over a period of five years.

Methods

208 patients (208 eyes) were included in this retrospective case series study. Intervention was an “as-needed” treatment model. Visual acuity (VA), central macular thickness (CMT), ophthalmic examination, and adverse events (AEs) were assessed in each visit. Snellen VA was converted to Early Treatment Diabetic Retinopathy Study letters for analysis.

Results

The average VA improved by 1.9 letters after one year (p = 0.017), and decreased by 2.4 letters over five years of treatment (p = 0.043). At the end of year five, 11.1 % of patients (23/208) had improved VA by more than 15 letters and 68.8 % (143/208) had VA improvement or loss less than or equal to 15 letters, while 20.2 % of patients (42/208) had a loss of more than 15 letters. Patients with VA of less than 35 letters at baseline showed significant VA improvement after five years of treatment. There was a positive relationship between injection numbers and VA improvement over the five-year period, after adjusting for age and baseline VA (p < 0.0005). Mean CMT decreased by 28.3 μm (p < 0.0005) over five years. Ocular AEs, serious adverse events (SAEs), and systemic SAEs occurred in 4.6 %, 0.48 %, and 2 % of patients, respectively, during the follow-up period.

Conclusions

The use of intravitreal ranibizumab in an as-needed treatment regimen over a five-year period was effective in maintaining vision in patients with nAMD and in reducing macular thickness, with a relatively low rate of adverse and serious adverse events.

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Acknowledgments

Dr. Haitao Li – Sydney Institute of Vision Science (critically reviewed the study proposal and collected data).

Contribution statement

Dr Meidong Zhu and Dr. Jamie Chew contributed equally to this work and share first authorship.

Conception and design: MZ, JC and AC; data collection: MZ, JC, GB, NJ, AS; analysis and interpretation of results: MZ, JC, GB, TH, AC; writing of the article: MZ, JC, GB, NJ, AC; critical revision of the article: MZ, JC, GB, TH, NJ, AS, KL, and AC; statistical expertise: KL; literature research: MZ, JC, AC.

Conflict of Interest Disclosure(s)

M Zhu, none; J Chew, none; G Broadhead, none; K Luo, none; N Joachim, none; T Hong, none; A Syed, none: A Chang, consultant for Alcon, Bayer, and Novartis.

Funding

This research is supported in part by an unrestricted grant from Novartis Pharmaceuticals Australia Pty Limited. The sponsor had no role in the design or conduct of this research.

Author information

Authors and Affiliations

  1. Sydney Institute of Vision Science, Level 13, 187 Macquarie Street, Sydney, 2000, Australia

    Meidong Zhu, Jamie K. Chew, Geoffrey K. Broadhead, Nichole Joachim, Thomas Hong, Adil Syed & Andrew A. Chang

  2. Save Sight Institute, The University of Sydney, Sydney, Australia

    Meidong Zhu, Jamie K. Chew, Geoffrey K. Broadhead, Adil Syed & Andrew A. Chang

  3. Statistics Department, Macquarie University, Sydney, Australia

    Kehui Luo

Authors
  1. Meidong Zhu
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  2. Jamie K. Chew
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Corresponding author

Correspondence to Andrew A. Chang.

Additional information

Dr. Meidong Zhu and Dr. Jamie Chew each contributed equally to this work and share first authorship.

Presentations

The results of this paper were presented in part at the 2013 Royal Australian and New Zealand College of Ophthalmologists (RANZCO) Annual Congress, Hobart, Tasmania, Australia.

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Zhu, M., Chew, J.K., Broadhead, G.K. et al. Intravitreal Ranibizumab for neovascular Age-related macular degeneration in clinical practice: five-year treatment outcomes. Graefes Arch Clin Exp Ophthalmol 253, 1217–1225 (2015). https://doi.org/10.1007/s00417-014-2799-8

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  • DOI: https://doi.org/10.1007/s00417-014-2799-8

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