Four‐week outcomes of vascular endothelial growth factor inhibitors for neovascular age‐related macular degeneration

Importance To assess early outcomes of intravitreal vascular endothelial growth factor (VEGF) inhibitor treatment in neovascular age-related macular degeneration (nAMD) before patients have a chance to miss or discontinue treatment. Background Intravitreal VEGF inhibitors used to treat nAMD have been compared in various ways. The present study compared the 4-week responses to the first injection of either aflibercept, bevacizumab, or ranibizumab. Design Observational study. Participants Treatment-naive nAMD patients with visual acuity (VA) taken 22 to 48 days after the first treatment with an intravitreal VEGF inhibitor. Methods An observational study from a prospectively designed database. Main outcome measures VA change from baseline and proportion of eyes judged active 22 to 48 days after the first treatment. Results The overall mean (95% confidence interval [CI]) VA change at 4 weeks was +3.7 (3.3, 4.0) letters. No pairwise comparisons in crude VA change or VA change after multivariate adjustment between the three agents were significant. However, after multivariate adjustment, more eyes treated with bevacizumab (90%) had active disease 4 weeks after the first injection than ranibizumab (84%; P = .013) and aflibercept (82%; P = .004). Older age, higher baseline vision and larger lesions were associated with lower VA change. Conclusion There was no significant difference in VA gains amongst all three drugs but ranibizumab and aflibercept seemed to be more efficacious in quelling disease activity 4 weeks after the first treatment. VA change after the first injection was driven largely by baseline characteristics such as age, baseline VA and lesion size.