Heterogeneous patient response to anti-VEGF treatment suggests close monitoring, individualized approaches
COPENHAGEN, Denmark — Many questions remain about predictors and causative factors, but interindividual variability in the response to age-related macular degeneration treatment strongly suggests that an individualized approach is prudent, according to a specialist.
"We do have a high degree of heterogeneity. Patients respond on a very individual basis, even with the same disease entity. This is reflected by the huge differences in the number of treatments we have to give," Frank G. Holz, MD, said at the meeting of the European Society of Ophthalmology.
Frank G. Holz
Stimuli for VEGF expression, clearance of endogenous VEGF, environmental and diet-related factors, individual disease progression, and differences in the distribution and elimination of molecules injected inside the eye may be potentially involved in the individual response to treatment.
"Genetic research has not provided useful answers so far, but we have to continue our search for potential other markers, perhaps with more refined modes for imaging," Holz said.
The overall results of pivotal anti-VEGF treatment in AMD studies have enabled identification of three potentially predictive characteristics for better outcomes: lesion size, lower best corrected visual acuity and younger age. Predictors of the number of injections were the amount of fluid at baseline and lesion characteristics; predominantly classic and minimally classic lesions required fewer treatments.
"However, the real world may be quite different, and we have no clue when we initiate treatment whether a patient will need a high or low number of injections. That’s why we need to see patients frequently, ideally every 4 weeks," Holz said.
Disclosure: Holz is a consultant to Bayer, Genentech and Novartis.