After 5 years of follow-up in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT), the visual acuity gains achieved during the first 2 years of anti-VEGF treatment were not maintained, the choroidal neovascular lesions continued to evolve with evidence of persistent activity in some eyes, and there was increased retinal thinning and geographic atrophy (GA).
The take-home message, nevertheless, is that 50% of the patients had 20/40 or better visual acuity at 5 years after enrollment.
“That visual acuity outcome would have been unimaginable in the era prior to anti-VEGF therapy,” said Daniel F. Martin, MD, CATT Study chairman and chairman, Cole Eye Institute, Cleveland Clinic, Cleveland, OH.
CATT randomly assigned patients with active AMD-related choroidal neovascularization (CNV) to 1 of 4 treatment groups to receive bevacizumab (Avastin, Genentech) or ranibizumab (Lucentis, Genentech) given monthly or as needed (PRN). At 1 year, patients assigned to the monthly treatment groups were re-randomized to monthly or PRN treatment.
Majority in follow-up study
Planned duration of CATT was 2 years, and the study ended in December 2011. In 2014, the National Eye Institute funded a follow-up study in which the 1,117 patients alive at the end of CATT were asked to return for a follow-up visit for evaluations that would include best corrected ETDRS visual acuity, color fundus photographs, fluorescein angiography (FA), and spectral domain optical coherence tomography. Patient records were also reviewed to determine anti-VEGF treatment since CATT ended as well as adverse events.
A total of 647 of the eligible patients (71%) participated in the follow-up study. They had a mean age of 83 years. Mean duration of follow-up since randomization was 5.5 years with a range of 4.3 to 7.1 years.
“A lot of people have asked if we are able to do a 10-year follow-up. Given the age of our patients, 5 years is probably the longest follow-up you will see from this study,” said Dr. Martin.
Most patients were receiving ongoing care for their AMD, although the mean number of visits per year declined from years 3 through 5 from 8 to 7 to 6 visits. The vast majority of patients (91%) received continued care at a CATT center, and the majority of patients (60%) were treated with one or more drugs differing from their CATT-assigned treatment. Almost no patient continued planned monthly treatment.
“For that reason, the goal of the CATT follow-up study was not to look at differences between drugs or dosing regimens,” Dr. Martin said. “The goal was to assess the global effects of any anti-VEGF therapy on visual acuity and anatomical outcomes after 5 years.”