By Cameron Johnston
FORT LAUDERDALE, FL -- May 8, 2007 -- Treating choroidal neovascularisation (CNV) secondary to age-related macular degeneration with a ranibizumab-based triple therapy seems to be more efficacious than dual-therapy that does not include ranibizumab, researchers reported here at the annual meeting of the annual meeting of the Association for Research in Vision and Ophthalmology (ARVO).
Although both regimens were effective, more patients on triple therapy had an improvement in vision as measured by "letter gained", while the rate at which patients lost vision was more or less comparable between the two groups.
In the study, 17 patients with classic subfoveal CNV who were treated with photodynamic therapy (PDT) with verteporfin, combined with intravitreal triamcinolone, and 15 were treated with triamcinolone, PDT plus ranibizumab.05%.
Principal investigator Rosa M. Romero-Castillo, MD, Asociación para Evitar la Ceguera en México, and physician, Centro médico ISSEMYM, Metepec, Mexico, presented the findings of the study in a poster session on May 6th.
Primary outcome measures were visual acuity, change in lesion size, changes in foveal thickness and retreatment rate.
After nine months of follow-up, 82.4% of the 17 patients who received dual therapy and 100% of patients on triple therapy had lost fewer than 11 letters in vision. At the same time point, 41.2% of 17 who received dual therapy and 60.0% of 15 on triple therapy showed an improvement in vision of at least 11 letters.
Retinal thickening was reduced significantly in both groups, although slightly more in the group receiving triple therapy (172 microns vs 156 microns).
An interesting point in this study was that there was no difference in outcome according to the patient's age, lesion size, or lesion type. In addition, visual acuity at baseline did have a significant impact on outcome.
The investigators cautioned that one of the limiting factors in this study was that the patients had only received a mean of one treatment each.
As for adverse events, 28% of patients who received dual therapy and 25% of those who received triple therapy had significant elevations in intraocular pressure that required emergency treatment. Cataract formation was seen in 14% of those on dual therapy compared with 12.5% of those on triple therapy. There were no cardio- or cerebrovascular events recorded.
Dr. Romero concluded that this study shows that triple therapy with PDT, intravitreal triamcinolone and ranibizumab was superior to dual therapy with PDT and intravitreal triamcinolone, at least in terms of the number of patients showing an improvement in vision.
Both treatments were safe, he said, although a large percentage of patients developed elevated intraocular pressure, which was to be expected, and both resulted in significant reductions in the rate at which vision was lost. This suggests that for many patients, both therapies are useful, although for some, triple therapy may have been more beneficial, particularly for those whose vision is worse at the outset, he said.
[Presentation title: Randomized, Double Blind, Controlled Study With Verteporfin Photodynamic Therapy and Intravitreal Triamcinolone(IVTA) vs Triple Therapy With Verteporfin Photodynamic Therapy, Intravitreal Triamcinolone and Intravitreal Ranibizumab in Patients With Subfoveal Choroidal Neovascularization(CNV) Secondary to Age-Related Macular Degeneration(AMD). Poster 72 - B181]
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