title: Key drivers of visual acuity gains in neovascular age-related macular degeneration in real life: findings from the AURA study.
abstract: OBJECTIVE
  To identify predictive markers for the outcomes of anti-vascular endothelial growth factor therapy for neovascular age-related macular degeneration (nAMD).
  
  
  METHODS
  AURA was a retrospective, observational, multicentre study that monitored the 2-year outcomes following intravitreal ranibizumab treatment in patients with nAMD. Using stepwise regression analysis, we evaluated the association between visual acuity outcomes, baseline characteristics and resource utilisation in order to determine which variables are significantly linked to outcomes in AURA. We also examined the relationship between visual acuity outcomes and number of injections received.
  
  
  RESULTS
  Analyses were performed using data from year 1 (n=1695) and year 2 completers (n=1184). Logistic analysis showed that baseline visual acuity score, age at start of therapy, number of ophthalmoscopies and optical coherence tomography (OCT) (combined) and number of injections (ranibizumab) were significant (p<0.05) prognostic factors for vision maintenance (loss <15 letters) or vision gain (≥15 letters). Patients who received >7 injections (in 1 year) or >14 injections (over 2 years) gained more letters and demonstrated greater vision maintenance (loss of <15 letters) than patients who received fewer injections. There was a significant (p<0.05) association between number of injections and national reimbursement schemes and OCT.
  
  
  CONCLUSIONS
  A number of factors that are predictive of treatment outcomes in a real-life setting were identified. Notably, the decline of treatment benefits may be linked to number of injections and a failure to visit clinicians and receive OCT as required. These findings may be helpful in guiding ophthalmologist treatment decisions under limited time and financial constraints.
  
  
  BACKGROUND
  NCT01447043.
authors.affiliation: Department of Ophthalmology, University of Bonn, Bonn, Germany.
authors.forename: Frank G
authors.initials: FG
authors.lastname: Holz
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, Institute of Eye Surgery, Waterford, Ireland.
authors.forename: Stephen
authors.initials: S
authors.lastname: Beatty
authors.affiliation: Department of Ophthalmology and Vision Sciences, University of Toronto, and St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Alan
authors.initials: A
authors.lastname: Berger
authors.affiliation: Department of Biomedical and Clinical Science Luigi Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy.
authors.forename: Matteo Giuseppe
authors.initials: MG
authors.lastname: Cereda
authors.affiliation: NIHR Biomedical Centre for Research in Ophthalmology, Moorfields Eye Hospital, London, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Hykin
authors.affiliation: Department of Biomedical and Clinical Science Luigi Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Staurenghi
authors.affiliation: Bayer Pharma AG, Berlin, Germany.
authors.forename: Kim
authors.initials: K
authors.lastname: Wittrup-Jensen
authors.affiliation: Bayer Pharma AG, Berlin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Altemark
authors.affiliation: Mapi Group, Real World Strategy and Analytics, Stockholm, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Nilsson
authors.affiliation: Mapi Group, Real World Strategy and Analytics, Stockholm, Sweden.
authors.forename: Kun
authors.initials: K
authors.lastname: Kim
authors.affiliation: NIHR Biomedical Centre for Research in Ophthalmology, Moorfields Eye Hospital, London, UK.|Department of Ophthalmology, King's College Hospital, London, UK.
authors.forename: Sobha
authors.initials: S
authors.lastname: Sivaprasad
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D009887:Ophthalmoscopy; D000069579:Ranibizumab / Q000008:administration & dosage*; D015861:Retinal Neovascularization / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D013997:Time Factors; 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; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab
keywords: Drugs; Macula; Retina; Treatment Medical; Vision