title: Individualized Ranibizumab Regimen Driven by Stabilization Criteria for Central Retinal Vein Occlusion: Twelve-Month Results of the CRYSTAL Study.
abstract: OBJECTIVE
  To assess the 12-month efficacy and safety profile of an individualized regimen of ranibizumab 0.5 mg driven by stabilization criteria in patients with macular edema secondary to central retinal vein occlusion (CRVO).
  
  
  METHODS
  A 24-month, prospective, open-label, single-arm, multicenter study.
  
  
  METHODS
  Three hundred fifty-seven patients.
  
  
  METHODS
  Patients were treated with monthly ranibizumab 0.5-mg injections (minimum of 3 injections) until stable visual acuity (VA) was maintained for 3 consecutive months. Thereafter, ranibizumab 0.5 mg was dosed as needed if monthly monitoring indicated a loss of VA resulting from disease activity.
  
  
  METHODS
  Mean change from baseline at month 12 in best-corrected VA (BCVA; primary end point) and safety over 12 months. The efficacy of this regimen in subgroups categorized by baseline BCVA score, CRVO duration, or presence of macular ischemia (exploratory analysis).
  
  
  RESULTS
  At baseline, the mean BCVA was 53.0 letters and mean CRVO duration was 8.9 months (median, 2.4 months). Ranibizumab 0.5-mg treatment resulted in a statistically significant mean gain in BCVA from baseline at month 12 of 12.3 letters (standard deviation [SD], 16.72 letters; P < 0.0001). The mean number of ranibizumab injections up to month 12 was 8.1 (SD, 2.77). At month 12, mean BCVA gains were similar with or without macular ischemia at baseline (11.6 vs. 12.1 letters); the mean BCVA gain was higher with baseline CRVO duration of less than 3 months (13.4 letters) than with a longer duration (≥3-<9 months, 11.1 letters; ≥9 months, 10.9 letters). Patients with lower baseline BCVA had larger mean BCVA gains at month 12 than those with higher baseline BCVA (≤39/40-59/≥60 and 18.0/12.7/8.9 letters, respectively), although the absolute BCVA at month 12 was higher with higher baseline BCVA. No new ocular or nonocular safety events were observed.
  
  
  CONCLUSIONS
  An individualized dosing regimen of ranibizumab 0.5 mg driven by stabilization criteria for up to 12 months resulted in significant BCVA gain in a broad population of patients with macular edema secondary to CRVO, including those with macular ischemia at baseline. The safety findings were consistent with those reported in previous ranibizumab studies in patients with CRVO.
authors.affiliation: Department of Ophthalmology, Rigshospitalet, and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. Electronic address: miclar01@regionh.dk.
authors.forename: Michael
authors.initials: M
authors.lastname: Larsen
authors.affiliation: Department of Ophthalmology, Vienna Reading Center, Medical University of Vienna, Vienna, Austria.
authors.forename: Sebastian M
authors.initials: SM
authors.lastname: Waldstein
authors.affiliation: The Eye Clinic, University of Sassari, Sassari, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Boscia
authors.affiliation: Department of Retinology, Klinik Pallas, Olten, Switzerland, and Department of Ophthalmology, University of Münster, Münster, Germany.
authors.forename: Heinrich
authors.initials: H
authors.lastname: Gerding
authors.affiliation: Institut de la Màcula, Centro Médico Teknon, and Barcelona Macula Foundation, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Monés
authors.affiliation: Department of Ophthalmology, Hôpital Lariboisière, AP-HP, Université Paris 7-Sorbonne Paris Cité, Paris, France.
authors.forename: Ramin
authors.initials: R
authors.lastname: Tadayoni
authors.affiliation: Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Priglinger
authors.affiliation: Novartis Pharma AG, Basel, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Wenzel
authors.affiliation: Novartis Pharma AG, Basel, Switzerland.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Barnes
authors.affiliation: Novartis Pharma AG, Basel, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Pilz
authors.affiliation: Novartis Pharma AG, Basel, Switzerland.
authors.forename: William
authors.initials: W
authors.lastname: Stubbings
authors.affiliation: St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom.
authors.forename: Ian
authors.initials: I
authors.lastname: Pearce
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D057285:Precision Medicine; D011446:Prospective Studies; D000069579:Ranibizumab / Q000008:administration & dosage*; D012170:Retinal Vein Occlusion / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D016037:Single-Blind Method; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab