Predicting Non-response to Ranibizumab in Patients with Neovascular Age-related Macular Degeneration. (December 2014)

• Record Type: Journal Article
• Authors: van Asten, Freekje; Rovers, Maroeska M.; Lechanteur, Yara T. E.; Smailhodzic, Dzenita; Muether, Philipp S.; Chen, John; den Hollander, Anneke I.; Fauser, Sascha; Hoyng, Carel B.; van der Wilt, Gert Jan; Klevering, B. Jeroen
• Is Part Of: Ophthalmic epidemiology. Volume 21:Number 6(2014)
• Page Start: 347
• Page End: 355
• Publication Date: 2014-12
• Subjects: Blindness -- Prevention -- Periodicals; Eye -- Diseases -- Epidemiology -- Periodicals; Ophthalmology -- Periodicals; 614.5997
• DOI: 10.3109/09286586.2014.949010
• Languages: English
• ISSNs: 0928-6586

Abstract

<abstract> <title>Abstract</title> <p> <italic>Purpose</italic>: To validate known and determine new predictors of non-response to ranibizumab in patients with neovascular age-related macular degeneration (AMD) and to incorporate these factors into a prediction rule.</p> <p> <italic>Methods</italic>: This multicenter, observational cohort study included 391 patients treated with ranibizumab for neovascular AMD. We performed genetic analysis for single nucleotide polymorphisms in AMD-associated genes and collected questionnaires regarding environmental factors and disease history. The primary outcome was non-response to treatment, defined as a loss of visual acuity ≥30% of letters.</p> <p> <italic>Results</italic>: Of the 391 patients, 47 were classified as non-responsive. Independent predictors for non-response were age, baseline visual acuity, diabetes mellitus and accumulation of risk alleles in the <italic>CFH, ARMS2</italic> and <italic>VEGF-A</italic> genes. The area under the receiver operating characteristic curve was 0.77 (95% confidence interval 0.70–0.84). We derived a clinical prediction rule, with possible total risk scores ranging from 0–19 points. The absolute risk of non-response varied from 3–52% between risk score groups.</p> <p> <italic>Conclusion</italic>: This is an important step towards a clinical prediction rule that can aid clinicians in identifying AMD patients with increased likelihood of non-response, and consequently contribute to making shared treatment decisions.</p> </abstract>