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Real-world unmet needs in the management of poorly responsive neovascular age-related macular degeneration in Europe: data from the FRB! Registry
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International audience. To evaluate the proportion, baseline predictors, and outcomes of neovascular age-related macular degeneration (nAMD) patients treated with a high burden of vascular endothelial growth factor (VEGF) inhibitor intravitreal injections (IVT) at two years in routine clinical practice. European retrospective data analysis from a prospectively designed observational outcomes registry: the Fight Retinal Blindness! (FRB!) Project. Treatment-naïve eyes (one eye per patient) initiating VEGF inhibitors IVT from January 2017 to March 2020 with 24 months of follow-up, a minimum of 3 injections, and no gap between visits exceeding 365 days were tracked in the registry. We analyzed three treatment burden (TB) groups defined by the mean interval of the three closest injections to the 24-month visit: (1) those with a high TB had injection interval ≤ 42 days, (2) those with a low TB had injection interval between >42 and <84 days and those with tolerable TB had injection interval between ≥ 84 and <365 days. Multinomial regression was used to evaluate baseline risk predictors. The main outcome measure was the proportion of patients that experienced a high TB at 2 years and its baseline predictors. We identified 2,038 eligible patients. The proportion of patients with a high TB was 25 % (514 patients) at 2 years, of which 59% (301 patients) and 41% (213 patients) had their choroidal neovascular (CNV) activity graded as “recently active” and “recently inactive” at last final visits. The proportions of patients with a low and tolerable TB were 45% (923 patients) and 29% (601 patients) at 2 years, respectively. The proportion of active CNV at 2 years were 46% (420 patients) and 47% (282 patients) in low and tolerable TB groups, respectively. Baseline risk predictors of high TB were younger age (Odds ratio (OR), 0.97; 95%CI, 0.96-0.99; P<0.01) and isolated active subretinal fluid (SRF) (OR, 3.85; 95%CI, 1.34-11.01; P=0.01). Type 3 CNV at baseline was significantly associated with a reduced risk of high TB at 2 years (OR, 0.26; 95%CI, 0.13-0.52; P<0.01). European unmet needs in nAMD were common in routine clinical practice, with a quarter of patients requiring every 6 weeks injections of conventional VEGF inhibitors at 2 years in Europe. This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.
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