Intravitreal steroids and anti-VEGF therapy beneficial in treatment of resistant Wet-AMD

USA: For the treatment of Wet-Age Related Macular Degeneration (Wet-AMD), a combination of steroids and anti-VEGF offers obvious anatomic improvement in resistant choroidal neovascularization (CNV), says a study presented at Association for Research in Vision and Ophthalmology (ARVO) 2022 Meeting.

The therapeutic utility of concurrent intravitreal steroids with anti-VEGF (inhibitory vascular endothelial growth factor) in choroidal neovascularization refractory to standard therapy is debatable. Alexandra Warter and colleagues assessed anatomic and visual changes following a simultaneous intervention in long-cohort research aiming to investigate the therapeutic safety and effectiveness of adjuvant steroids with anti-VEGF in resistant chronic Wet-Age Related Macular Degeneration.

Researchers conducted a retrospective observational clinical analysis on a sequential cohort of patients' eyes with persistent choroidal neovascularization that was architecturally resistant to aggressive high-dose high-frequency (HDHF) monotherapy for this investigation (i.e.: monthly 4 mg aflibercept). A total of 12 eyes were investigated with unresponsive choroidal neovascularization despite therapy with alternating anti-VEGF medications. Following high-dose high-frequency therapy, resistance was defined as persisting retinal fluid. The combination consisted of administering anti-VEGF and steroids at the same time, followed by two weeks of preventive topical antiglaucoma medicine. For four months, slit-lamp, visual acuity (BCVA), intraocular pressure (IOP), and optical coherence tomography (OCT) measures of the central retinal thickness (CRT) were taken every four weeks. Baseline predictors of therapy effectiveness were examined. Changes in BCVA, IOP, and CRT were among the outcomes.

The key findings of this study were as follows:

1. The preliminary study revealed no safety data problems.

2. Anatomic results were statistically significant, demonstrating a reduction in CRT compared to baseline; paired analysis revealed an average CRT reduction of 50.90 m at one month, 76.5 m at two months, and 86.33 m at three months.

3. There was a strong relationship between CNV type and CRT lowering.

In conclusion, other investigations found visual and anatomic alterations as a result of combination, although not in chronic monotherapy-resistant eyes. Overall disease improvement was noted in such eyes. As a result, combined treatment may be beneficial in the treatment of resistant Wet-AMD.

Reference:

Alexandra Warter, Melina Cavichini, Carlo Miguel B. Galang, Fritz Gerald Kalaw., "Adjuvant use of long-acting intravitreal steroids and anti-VEGF agents in monotherapy resistant chronic Wet-Age Related Macular Degeneration," ARVO 2022.