Predictors of anti-VEGF treatment response in neovascular age-related macular degeneration
Abstract
Currently available evidence on predictors of anti-vascular endothelial growth factor (VEGF) treatment response in neovascular age-related macular degeneration was reviewed. No meta-analysis of results is possible because of a lack of controlled and randomized trials, varying treatment regimes and outcome measures used, as well as suboptimal reporting. For genetic factors, most evidence to date has been generated for single nucleotide polymorphisms (SNPs) in the complement factor H (CFH), and VEGF-A genes. Just under half of the SNPs assessed in the CFH gene and 15% of the SNPs assessed in the VEGF gene were found to be associated with visual outcomes or the number of injections required during follow-up. Some evidence suggests association of worse treatment outcomes as well as a younger age at treatment onset with an increasing number of risk alleles in known risk genes (CFH and ARMS2/HTRA1) and polymorphisms in the VEGF-A gene. Clinical factors such as higher age, a better visual acuity (VA), a larger choroidal neovascularization (CNV) lesion at baseline, and a delay between symptom onset and initiation of treatment of more than 3 weeks also impact outcomes. Conversely, a worse acuity at baseline predicted more gain in vision. Overall, patients presenting with good acuity at baseline were more likely to have good VA at follow up, but the gain afforded by treatment was impacted by a ceiling effect. Most available evidence suggests a strong association of clinical factors suc…
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Older age is associated with worse treatment outcomes with anti-VEGF therapy in nAMD, as are poorer visual acuity and larger choroidal neovascularization (CNV) lesions at presentation.
“For example, older age is associated with worse treatment outcomes with anti-VEGF therapy in nAMD, as is poorer visual acuity and larger choroidal neovascularization (CNV) lesions at presentation.6”
From <i>ANO2</i> Genetic Variants and Anti-VEGF Treatment Response in Neovascular AMD: A Pharmacogenetic Substudy of VIEW 1 and VIEW 2 (2024) · cites this paper as [6]
Evidence of the influence of genetic polymorphisms in the response to anti-VEGF treatment in nAMD is inconsistent.
“Evidence of the influence of genetic polymorphisms in the response to anti-VEGF treatment in nAMD is inconsistent.6”
From <i>ANO2</i> Genetic Variants and Anti-VEGF Treatment Response in Neovascular AMD: A Pharmacogenetic Substudy of VIEW 1 and VIEW 2 (2024) · cites this paper as [6]
The largest body of evidence on genetic variants associated with treatment response is related to ARMS2/HTRA1, CFH, and VEGFA, but results are conflicting.
“The largest body of evidence on genetic variants associated with treatment response is related to ARMS2/HTRA1, CFH, and VEGFA,6,10,17–19 but even here results are conflicting.”
From <i>ANO2</i> Genetic Variants and Anti-VEGF Treatment Response in Neovascular AMD: A Pharmacogenetic Substudy of VIEW 1 and VIEW 2 (2024) · cites this paper as [6]
A degree of variability in results on genetic polymorphisms and anti-VEGF response is likely due to various study types, heterogeneous patient populations, different anti-VEGF agents, different dose regimens, and different definitions of response using different functional and anatomic end points.
“A degree of variability is likely due to the fact that results have emerged from various study types (observational and clinical), with heterogeneous patient populations treated with different anti-VEGF agents, with different dose regimens, and with response to treatment defined using different functional and anatomic end points.6,10,17”
From <i>ANO2</i> Genetic Variants and Anti-VEGF Treatment Response in Neovascular AMD: A Pharmacogenetic Substudy of VIEW 1 and VIEW 2 (2024) · cites this paper as [6]
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Self-citationVEGF regulates local inhibitory complement proteins in the eye and kidney
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“6 A degree of variability is likely due to the fact that results have emerged from various study types (observational and clinical), with heterogeneous patient populations treated with different anti-VEGF agents, with different dose regimens, and with response to treatment defined using different…”
Self-citation
- Authors
- Finger, R. P., Wickremasinghe, S. S., Baird, P. N., & Guymer, R. H.
- Affiliations
- University of Bonn (DE)
- The University of Melbourne (AU)
- Corresponding author
- Finger, Robert P.
- Venue
- Survey of Ophthalmology
- Publisher
- Elsevier BV
- Published
- 2014-01
- Volume
- 59
- Issue
- 1
- Pages
- 1-18
- ISSN
- 0039-6257 (ISSN-L)
- OpenAlex
- W2139373552
- Cited by
- 144
- References
- 8
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 13 · 2023: 7 · 2022: 9 · 2021: 7 · 2020: 14 · 2019: 17 · 2018: 16 · 2017: 18 · 2016: 12 · 2015: 14 · 2014: 6 · 2013: 1 · 2012: 1
- FWCI
- 1.92
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Survey of Ophthalmology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Pfizer
- Regeneron Pharmaceuticals
- Genentech
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
- Keywords
- neovascular age-related macular degeneration, anti-VEGF therapy, predictors of treatment response, complement factor H, baseline visual acuity, age at treatment initiation, genetic risk factors, smoking
- MeSH terms
- Bevacizumab, Ranibizumab, Humans, Visual Acuity, Treatment Outcome, Angiogenesis Inhibitors, Vascular Endothelial Growth Factor A, Wet Macular Degeneration, Antibodies, Monoclonal, Humanized
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