title: Time to initial clinician-reported inactivation of neovascular age-related macular degeneration treated primarily with ranibizumab.
abstract: OBJECTIVE
  To characterize in more detail routine treatment patterns of intravitreal ranibizumab for neovascular age-related macular degeneration (nAMD), we analyzed the length of time and the number of injections required until lesions with choroidal neovascularization (CNV) were first graded inactive.
  
  
  METHODS
  Database observational study.
  
  
  METHODS
  Treatment-naïve eyes receiving predominantly ranibizumab for nAMD in routine clinical practice that were tracked in the Fight Retinal Blindness! observational registry.
  
  
  METHODS
  Eyes treated with ranibizumab were followed until CNV was first reported to be "inactive" (i.e., absence of intraretinal fluid and hemorrhages).
  
  
  METHODS
  The length of time until lesion inactivation occurred and the number of injections required.
  
  
  RESULTS
  A total of 1096 eyes (65.8% from women) were included in the study. The median number of weeks until a lesion was graded as inactive after beginning treatment was 15 weeks. One to 3 injections were sufficient to inactivate the lesion in 61.1% of eyes. A mean change in visual acuity of +5.5 logarithm of the minimum angle of resolution letters (95% confidence interval, 4.8-6.3) was found from treatment initiation to the time that eyes were reported as inactive. In eyes with a mean treatment frequency less than every 5.3 weeks, a median of only 3 injections (mean=3.7) were required before lesions with CNV were graded as inactive, but if the mean treatment interval extended beyond 5.3 weeks, the median number of injections required increased sharply to 6 injections (mean, 7 injections). Occult lesions became inactive more slowly than classic lesions.
  
  
  CONCLUSIONS
  Most lesions with CNV became inactive with 3 injections of ranibizumab, but a small proportion remained active for more than 12 months. Injection frequency and lesion type were the main factors that predicted the time and number of injections required to render lesions inactive.
authors.affiliation: The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Gillies
authors.affiliation: The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: Campain
authors.affiliation: The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Walton
authors.affiliation: School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Judy M
authors.initials: JM
authors.lastname: Simpson
authors.affiliation: Marsden Eye Specialists, Parramatta, New South Wales, Australia.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Arnold
authors.affiliation: Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.
authors.forename: Robyn H
authors.initials: RH
authors.lastname: Guymer
authors.affiliation: Lions Eye Institute, Centre for Ophthalmology and Vision Science, University of Western Australia, Crawley, Western Australia.
authors.forename: Ian L
authors.initials: IL
authors.lastname: McAllister
authors.affiliation: The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Retina Associates, Chatswood, New South Wales, Australia.
authors.forename: Alex P
authors.initials: AP
authors.lastname: Hunyor
authors.affiliation: Academic Unit of Ophthalmology, Australian National University, Acton, Australian Capital Territory.
authors.forename: Rohan W
authors.initials: RW
authors.lastname: Essex
authors.affiliation: University of Western Australia Department of Population Health, Perth, Western Australia.
authors.forename: Nigel
authors.initials: N
authors.lastname: Morlet
authors.affiliation: The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. Electronic address: daniel.barthelmes@usz.ch.
authors.forename: Daniel
authors.initials: D
authors.lastname: Barthelmes
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D000069579:Ranibizumab; D019233:Retreatment; D013997:Time Factors; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab