Reactivation of CNV after Discontinuation of Bevacizumab Treatment of Age-Related Macular Degeneration

Analyzing subgroups and treatment discontinuation in a Finnish cohort of patients with neovascular AMD

Purpose To study the regional detailed visual outcome and treatment discontinuation of neovascular age-related macular degeneration (nAMD). Methods Clinical records of 110 patients treated for nAMD at the sole referral center in the Helsinki region were analysed retrospectively. The follow-up was up to the fourth year. Results The mean visual acuity (VA) at baseline was 56.3 (SD 16.2) letters. The mean last VA at the first year was 59.7 (20.2), and the corresponding values for the second, third and fourth years were 60.8 (20.6), 60.0 (19.0) and 59.7 (19.3). The mean difference from baseline was +3.39 (SD 14.6), +3.59 (17.6), +0.08 (18.9) and +3.08 (14.3). The number of patients declined each year, with only 51 % of the patients being in treatment until the fourth year. The patients with shorter duration of follow-up tended to have a lower baseline VA, lesser gains and an earlier decline in VA. The VA levels at the last visit were poorer in the shorter follow group. The initial VA response predicted later VA, whereas VA at baseline, age or sex had no effect. However, the effect vanished with a longer time in treatment. Conclusions Long-term VA stabilization was obtained in a regional material. Patients with neovascular AMD consists of cohorts with varying visual outcome and treatment time. Many of the patients benefit from the treatment for some time, however. When comparing real-world results, the outcome of the different follow-up time cohorts should be considered. This calls for new methods for analysing real world nAMD treatment results. Key words: neovascular age-related macular degeneration, anti-VEGF treatment, visual acuity, real-world studies.