Growth of geographic atrophy in the comparison of age-related macular degeneration treatments trials

To evaluate the growth of geographic atrophy (GA) during anti-vascular endothelial growth factor (VEGF) therapy. Cohort within a clinical trial. Patients included in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT). Participants were randomly assigned to injections of rani...

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Vydáno v:	Ophthalmology (Rochester, Minn.) Ročník 122; číslo 4; s. 809
Hlavní autoři:	Grunwald, Juan E, Pistilli, Maxwell, Ying, Gui-Shuang, Maguire, Maureen G, Daniel, Ebenezer, Martin, Daniel F
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States 01.04.2015
Témata:	Aged Aged, 80 and over Angiogenesis Inhibitors - therapeutic use Antibodies, Monoclonal, Humanized - therapeutic use Bevacizumab Cohort Studies Complement C3 - genetics Complement Factor H - genetics Female Fluorescein Angiography Geographic Atrophy - genetics Geographic Atrophy - pathology High-Temperature Requirement A Serine Peptidase 1 Humans Intravitreal Injections Male Photography Polymorphism, Single Nucleotide Proteins - genetics Ranibizumab Serine Endopeptidases - genetics Toll-Like Receptor 3 - genetics Vascular Endothelial Growth Factor A - antagonists & inhibitors Visual Acuity - physiology Wet Macular Degeneration - diagnosis Wet Macular Degeneration - drug therapy Wet Macular Degeneration - genetics
ISSN:	1549-4713, 1549-4713
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Abstract	To evaluate the growth of geographic atrophy (GA) during anti-vascular endothelial growth factor (VEGF) therapy. Cohort within a clinical trial. Patients included in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT). Participants were randomly assigned to injections of ranibizumab or bevacizumab and to a 2-year dosing regimen of monthly or pro re nata (PRN) or to monthly for 1 year and PRN the following year. Digital color photographs and fluorescein angiograms at baseline and 1 and 2 years were evaluated for GA, and the total area of GA was measured by 2 graders masked to treatment; differences were adjudicated. Multivariate linear mixed models of the annual change in the square root of the area included baseline demographic, treatment, and ocular characteristics on imaging as candidate risk factors. Geographic atrophy growth rate. Among 1185 participants, 86 (7.3%) had GA at baseline, 120 (10.1%) developed GA during year 1, and 36 (3.0%) developed GA during year 2. Among 194 eyes evaluable for growth, the rate was 0.43 mm/yr (standard error [SE], ±0.03 mm/year). In multivariate analysis, the growth rate was 0.37 mm/year in eyes receiving bevacizumab and 0.49 mm/year in eyes receiving ranibizumab (difference, 0.11 mm/yr; 95% confidence interval [CI], 0.01-0.22; P = 0.03). Growth rate did not differ between eyes treated monthly and PRN (P = 0.85). Eyes with subfoveal choroidal neovascularization (CNV) lesions had a lower growth rate than eyes with nonsubfoveal CNV lesions (difference, 0.12; 95% CI, 0.01-0.22; P = 0.03). Eyes with GA farther from the fovea had higher growth rates by 0.14 (95% CI, 0.01-27) mm/year for every millimeter farther from the fovea. The growth rate was 0.58 mm/year for eyes with predominantly classic lesions, 0.41 mm/year for eyes with minimally classic lesions, and 0.30 mm/year for eyes with occult only lesions (P < 0.01). The growth rate in eyes having a fellow eye with GA was higher by 0.13 mm/year (95% CI, 0.01-0.24; P = 0.03) than in eyes without GA in the fellow eye. Eyes with epiretinal membrane had a higher growth rate than eyes without epiretinal membrane (difference, 0.16; 95% CI, 0.03-0.30; P = 0.02). Geographic atrophy growth depends on several ocular factors. Ranibizumab may accelerate GA growth.
AbstractList	To evaluate the growth of geographic atrophy (GA) during anti-vascular endothelial growth factor (VEGF) therapy. Cohort within a clinical trial. Patients included in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT). Participants were randomly assigned to injections of ranibizumab or bevacizumab and to a 2-year dosing regimen of monthly or pro re nata (PRN) or to monthly for 1 year and PRN the following year. Digital color photographs and fluorescein angiograms at baseline and 1 and 2 years were evaluated for GA, and the total area of GA was measured by 2 graders masked to treatment; differences were adjudicated. Multivariate linear mixed models of the annual change in the square root of the area included baseline demographic, treatment, and ocular characteristics on imaging as candidate risk factors. Geographic atrophy growth rate. Among 1185 participants, 86 (7.3%) had GA at baseline, 120 (10.1%) developed GA during year 1, and 36 (3.0%) developed GA during year 2. Among 194 eyes evaluable for growth, the rate was 0.43 mm/yr (standard error [SE], ±0.03 mm/year). In multivariate analysis, the growth rate was 0.37 mm/year in eyes receiving bevacizumab and 0.49 mm/year in eyes receiving ranibizumab (difference, 0.11 mm/yr; 95% confidence interval [CI], 0.01-0.22; P = 0.03). Growth rate did not differ between eyes treated monthly and PRN (P = 0.85). Eyes with subfoveal choroidal neovascularization (CNV) lesions had a lower growth rate than eyes with nonsubfoveal CNV lesions (difference, 0.12; 95% CI, 0.01-0.22; P = 0.03). Eyes with GA farther from the fovea had higher growth rates by 0.14 (95% CI, 0.01-27) mm/year for every millimeter farther from the fovea. The growth rate was 0.58 mm/year for eyes with predominantly classic lesions, 0.41 mm/year for eyes with minimally classic lesions, and 0.30 mm/year for eyes with occult only lesions (P < 0.01). The growth rate in eyes having a fellow eye with GA was higher by 0.13 mm/year (95% CI, 0.01-0.24; P = 0.03) than in eyes without GA in the fellow eye. Eyes with epiretinal membrane had a higher growth rate than eyes without epiretinal membrane (difference, 0.16; 95% CI, 0.03-0.30; P = 0.02). Geographic atrophy growth depends on several ocular factors. Ranibizumab may accelerate GA growth. To evaluate the growth of geographic atrophy (GA) during anti-vascular endothelial growth factor (VEGF) therapy.PURPOSETo evaluate the growth of geographic atrophy (GA) during anti-vascular endothelial growth factor (VEGF) therapy.Cohort within a clinical trial.DESIGNCohort within a clinical trial.Patients included in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT).PARTICIPANTSPatients included in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT).Participants were randomly assigned to injections of ranibizumab or bevacizumab and to a 2-year dosing regimen of monthly or pro re nata (PRN) or to monthly for 1 year and PRN the following year. Digital color photographs and fluorescein angiograms at baseline and 1 and 2 years were evaluated for GA, and the total area of GA was measured by 2 graders masked to treatment; differences were adjudicated. Multivariate linear mixed models of the annual change in the square root of the area included baseline demographic, treatment, and ocular characteristics on imaging as candidate risk factors.METHODSParticipants were randomly assigned to injections of ranibizumab or bevacizumab and to a 2-year dosing regimen of monthly or pro re nata (PRN) or to monthly for 1 year and PRN the following year. Digital color photographs and fluorescein angiograms at baseline and 1 and 2 years were evaluated for GA, and the total area of GA was measured by 2 graders masked to treatment; differences were adjudicated. Multivariate linear mixed models of the annual change in the square root of the area included baseline demographic, treatment, and ocular characteristics on imaging as candidate risk factors.Geographic atrophy growth rate.MAIN OUTCOME MEASURESGeographic atrophy growth rate.Among 1185 participants, 86 (7.3%) had GA at baseline, 120 (10.1%) developed GA during year 1, and 36 (3.0%) developed GA during year 2. Among 194 eyes evaluable for growth, the rate was 0.43 mm/yr (standard error [SE], ±0.03 mm/year). In multivariate analysis, the growth rate was 0.37 mm/year in eyes receiving bevacizumab and 0.49 mm/year in eyes receiving ranibizumab (difference, 0.11 mm/yr; 95% confidence interval [CI], 0.01-0.22; P = 0.03). Growth rate did not differ between eyes treated monthly and PRN (P = 0.85). Eyes with subfoveal choroidal neovascularization (CNV) lesions had a lower growth rate than eyes with nonsubfoveal CNV lesions (difference, 0.12; 95% CI, 0.01-0.22; P = 0.03). Eyes with GA farther from the fovea had higher growth rates by 0.14 (95% CI, 0.01-27) mm/year for every millimeter farther from the fovea. The growth rate was 0.58 mm/year for eyes with predominantly classic lesions, 0.41 mm/year for eyes with minimally classic lesions, and 0.30 mm/year for eyes with occult only lesions (P < 0.01). The growth rate in eyes having a fellow eye with GA was higher by 0.13 mm/year (95% CI, 0.01-0.24; P = 0.03) than in eyes without GA in the fellow eye. Eyes with epiretinal membrane had a higher growth rate than eyes without epiretinal membrane (difference, 0.16; 95% CI, 0.03-0.30; P = 0.02).RESULTSAmong 1185 participants, 86 (7.3%) had GA at baseline, 120 (10.1%) developed GA during year 1, and 36 (3.0%) developed GA during year 2. Among 194 eyes evaluable for growth, the rate was 0.43 mm/yr (standard error [SE], ±0.03 mm/year). In multivariate analysis, the growth rate was 0.37 mm/year in eyes receiving bevacizumab and 0.49 mm/year in eyes receiving ranibizumab (difference, 0.11 mm/yr; 95% confidence interval [CI], 0.01-0.22; P = 0.03). Growth rate did not differ between eyes treated monthly and PRN (P = 0.85). Eyes with subfoveal choroidal neovascularization (CNV) lesions had a lower growth rate than eyes with nonsubfoveal CNV lesions (difference, 0.12; 95% CI, 0.01-0.22; P = 0.03). Eyes with GA farther from the fovea had higher growth rates by 0.14 (95% CI, 0.01-27) mm/year for every millimeter farther from the fovea. The growth rate was 0.58 mm/year for eyes with predominantly classic lesions, 0.41 mm/year for eyes with minimally classic lesions, and 0.30 mm/year for eyes with occult only lesions (P < 0.01). The growth rate in eyes having a fellow eye with GA was higher by 0.13 mm/year (95% CI, 0.01-0.24; P = 0.03) than in eyes without GA in the fellow eye. Eyes with epiretinal membrane had a higher growth rate than eyes without epiretinal membrane (difference, 0.16; 95% CI, 0.03-0.30; P = 0.02).Geographic atrophy growth depends on several ocular factors. Ranibizumab may accelerate GA growth.CONCLUSIONSGeographic atrophy growth depends on several ocular factors. Ranibizumab may accelerate GA growth.
Author	Pistilli, Maxwell Grunwald, Juan E Martin, Daniel F Ying, Gui-Shuang Daniel, Ebenezer Maguire, Maureen G
Author_xml	– sequence: 1 givenname: Juan E surname: Grunwald fullname: Grunwald, Juan E email: juangrun@mail.med.upenn.edu organization: Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: juangrun@mail.med.upenn.edu – sequence: 2 givenname: Maxwell surname: Pistilli fullname: Pistilli, Maxwell organization: Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania – sequence: 3 givenname: Gui-Shuang surname: Ying fullname: Ying, Gui-Shuang organization: Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania – sequence: 4 givenname: Maureen G surname: Maguire fullname: Maguire, Maureen G organization: Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania – sequence: 5 givenname: Ebenezer surname: Daniel fullname: Daniel, Ebenezer organization: Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania – sequence: 6 givenname: Daniel F surname: Martin fullname: Martin, Daniel F organization: Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/25542520$$D View this record in MEDLINE/PubMed
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Copyright	Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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Snippet	To evaluate the growth of geographic atrophy (GA) during anti-vascular endothelial growth factor (VEGF) therapy. Cohort within a clinical trial. Patients... To evaluate the growth of geographic atrophy (GA) during anti-vascular endothelial growth factor (VEGF) therapy.PURPOSETo evaluate the growth of geographic...
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SubjectTerms	Aged Aged, 80 and over Angiogenesis Inhibitors - therapeutic use Antibodies, Monoclonal, Humanized - therapeutic use Bevacizumab Cohort Studies Complement C3 - genetics Complement Factor H - genetics Female Fluorescein Angiography Geographic Atrophy - genetics Geographic Atrophy - pathology High-Temperature Requirement A Serine Peptidase 1 Humans Intravitreal Injections Male Photography Polymorphism, Single Nucleotide Proteins - genetics Ranibizumab Serine Endopeptidases - genetics Toll-Like Receptor 3 - genetics Vascular Endothelial Growth Factor A - antagonists & inhibitors Visual Acuity - physiology Wet Macular Degeneration - diagnosis Wet Macular Degeneration - drug therapy Wet Macular Degeneration - genetics
Title	Growth of geographic atrophy in the comparison of age-related macular degeneration treatments trials
URI	https://www.ncbi.nlm.nih.gov/pubmed/25542520 https://www.proquest.com/docview/1666296419
Volume	122
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