SCORE2 Report 20: Relationship of Treatment Discontinuation With Visual Acuity and Central Subfield Thickness Outcomes

• Published in: American journal of ophthalmology 2023-04, Vol.248, p.157-163
• Main Authors: Scott, Ingrid U., Oden, Neal L., VanVeldhuisen, Paul C., Ip, Michael S., Blodi, Barbara A.
• Format: Article
• Language: English
• Subjects: Angiogenesis Inhibitors - therapeutic use; Bevacizumab - therapeutic use; Humans; Intravitreal Injections; Macular Edema - chemically induced; Macular Edema - diagnosis; Macular Edema - drug therapy; Receptors, Vascular Endothelial Growth Factor - therapeutic use; Retinal Vein Occlusion - chemically induced; Retinal Vein Occlusion - diagnosis; Retinal Vein Occlusion - drug therapy; Tomography, Optical Coherence; Vascular Endothelial Growth Factor A; Visual Acuity
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2022.12.026

To investigate the relationship of anti-vascular endothelial growth factor (anti-VEGF) treatment discontinuation with baseline factors and outcomes in eyes treated initially with aflibercept or bevacizumab for macular edema from central or hemiretinal vein occlusion. Long-term follow-up after a randomized clinical trial from 64 US centers. Analysis included 150 SCORE2 Month 60 completers classified into 3 groups: discontinued treatment early, treated intermittently, and treated continuously. Outcomes included visual acuity (VA) and central subfield thickness (CST). Patients who discontinued treatment early were younger (60.9 years, vs 66.7 and 70.5 for the treated intermittently and treated continuously groups; P = .001), and 17.4% were Black, compared to 19.5% and 4.7% for the treated intermittently and treated continuously groups (P = .006). At Month 60, the discontinued treatment early group had a higher proportion with complete resolution of macular edema (69.6%) than those treated intermittently (15.0%) and treated continuously (15.7%) (P < .001). Least-squares means analyses over follow-up demonstrated that the discontinued treatment early group had a lower mean CST (257 µm) than the treated intermittently (CST = 303 µm, P = .02) and treated continuously (CST = 300 µm, P = .01) groups. Compared to those treated continuously, those who discontinued treatment early were younger and more likely Black. The discontinued treatment early group had a higher proportion with complete resolution of macular edema at Month 60, and a lower mean CST over follow-up, but not better VA, than the treated continuously and treated intermittently groups. Results support the need for continued monitoring and individualized treatment for patients treated with anti-VEGF for macular edema from central or hemiretinal vein occlusion.