Fluid-Free Status Associated with Visual Outcomes in Patients with Wet AMD

Retina fluid is used to measure wet age-related macular degeneration (AMD) disease activity; however, limited evidence exists regarding early retinal fluid-free status and subsequent visual outcomes. A post-hoc analysis of pooled data from the HAWK and HARRIER trials suggests that patients who achieve early fluid-free status following anti-vascular endothelial growth factor treatment may have better visual outcomes than those with fluid present. The results of the study were published as part of the American Society of Retina Specialists 2020 Virtual Annual Meeting.

Early fluid-free status was defined as the absence of intraretinal fluid (IRF) and subretinal fluid (SRF) at 12 weeks, independent of treatment. Treatment-naïve patients (n=1,459) aged ≥50 years with choroidal neovascularization lesions secondary to wet AMD with presence of subfoveal IRF and/or SRF and best-corrected visual acuity (BCVA) of 78–23 Early Treatment Diabetic Retinopathy Study (ETDRS) Letters were randomized to receive brolucizumab 6 mg or aflibercept 2 mg. Patients were grouped into two cohorts, in a treatment-agnostic manner, based on fluid status at week 12: fluid-free (IRF and SRF) and fluid present (IRF and/or SRF). Mean change in BCVA from baseline was evaluated at 12, 24, 48, and 96 weeks.

At week 12, 1,075 patients (74%) were fluid-free and 384 (26%) had fluid present. At week 12, mean BCVA change from baseline was +6.4 ETDRS Letters for the fluid-free cohort and +4.9 for the fluid-present cohort; this trend continued for 96 weeks. After week 12, BCVA improvements from baseline in patients with early fluid-free status were also greater than that of fluid-present patients at the same time points: weeks 24 (+6.9 vs. +5.1), 48 (+7.4 vs. +5.8), and 96 (+6.5 vs. +4.7).

“The improvements occur as early as four weeks following the last loading dose (week 12) and continue to 96 weeks, demonstrating better long-term visual outcomes,” the researchers concluded. “The results of this current post-hoc analysis [add] to the understanding of anatomical and visual outcomes.”

Jhaveri CD, Wykoff CC, Khanani AM, et al. Early Fluid-Free Status & Long-Term BCVA Outcomes with Anti-VEGF Treatment in nAMD: Post Hoc Analysis of Pooled Data From HAWK & HARRIER Studies. Presented during the ASRS 2020 Virtual Annual Meeting, July 24-26, 2020.