Ranibizumab curtails blindness long term

Seattle-Long-term results reveal that intravitreal ranibizumab (Lucentis, Genentech) has made a marked difference in the rates of blindness related to wet age-related macular degeneration (AMD), said Peter Cackett, MB BS.

“Our data show a significant reduction in legal blindness secondary to wet AMD since beginning intravitreal ranibizumab service in 2007,” said Dr. Cackett, a consultant ophthalmologist at The Edinburgh Clinic, Scotland.

The overall incidence rate of legal blindness that could be attributed to wet AMD in this cohort declined from 10.6 cases per 100,000 in 2004 to 4.3 cases per 100,000 in 2012. This corresponded to a reduction of 59%.

“In real-world practice, we show that it is working and reducing blindness,” Dr. Cackett said.

Intravitreal ranibizumab has been routinely used to treat patients with wet AMD in the United Kingdom since 2007, but its effect on the rates of blindness have not been widely reported in the literature. In addition, there is little long-term follow-up data.

Dr. Cackett and colleagues predicted that the new intervention of intravitreal ranibizumab would reduce blind registration rates that were related to wet AMD in Scotland. They used blind registration data for the population of SE Scotland, and retrospectively analyzed the case-notes of their first cohort of 100 patients who began using intravitreal ranibizumab in 2007, and used that for a long-term follow up of 5 years, ending in 2012.

The incidence of legal blindness from all causes decreased from 27.8 per 100,000 in 2004 to 20.4 per 100,000 in 2011, which corresponded to a reduction of 27%.

For our first cohort of 100 patients, Dr. Cackett said, the mean visual acuity at the beginning of treatment was logmar 0.60 but after 5 years of follow up, it was logmar 0.68. This corresponded to a mean loss of 4 ETDRS chart letters.

The number of injections needed per year also declined. While the average number of injections was 9.7 in the first year, and mean number of clinic visits 9, that number gradually decreased to 0.5 by the fifth year.

“Further work comparing the cost of the intravitreal ranibizumab versus the economic benefit of preventing blindness will hopefully justify the high expenditure and workload in providing this service,” Dr. Cackett said. “The future appears a lot brighter for the treatment of wet AMD.”

For more articles in this issue of Ophthalmology Times Conference Brief,click here.