Optimizing Anti-VEGF Treatment Outcomes in Neovascular AMD and DME - Episode 10
Experts discuss the comparison of age-related macular degeneration treatments trials (CATT) and how today’s retina specialists can apply the results in their daily practice.
Ehsan Rahimy, MD: Veeral, 2- and 5-year results from the CATT study found no significant difference in outcomes between off-label bevacizumab and ranibizumab in neovascular AMD [age-related macular degeneration]. [It is an] older study, but obviously one of our landmark clinical trials. How should retina specialists of today, as you [said], we have a lot of trainees, a lot of fellows that are coming up, how do they translate these results into the real world?
Veeral Sheth, MD, MBA, FASRS, FACS: I think you mentioned it’s an older study, but I think it’s an important study. I think we have to put ourselves back to when that study was happening. We had these questions. We had bevacizumab, we had ranibizumab, and there’s a huge gap in the cost of those treatments. And so the question comes up, if we independently look at these things against each other, are they going to bear out to be very similar in the results we see in our patients? To your point, at 2 years and 5 years, we saw that they were very similar. Bevacizumab and ranibizumab performed very similarly, which is great. That means that we’ve got 2 great options out there for us.
Now fast forward to 2023, back to Ali’s point, we have 10 options. So how do we apply that information to 2023? And I think [in] general we’ve got lots of good options. I don’t think there’s a study that’s ever going to be done that compares any of these things against each other in a meaningful way where we can kind of go back and say this was like the CATT study. But I think it helped inform us. It helps us build future studies and figure out from a cost effectiveness standpoint. What are we willing to kind of do for patients and how are we going to manage this in the long run in terms of sustainability? So it’s a different question now. It’s a more difficult question now. We do have different mechanisms of action. We have different disabilities. And so I think the equation is changing. But I think as a study, it was a really important study. I think the most fundamental thing it proved to us is that we have multiple good options for patients.
Ehsan Rahimy, MD: It was also disappointing, right? After 5 years, patients are essentially losing vision. They’re back to zero. That was Jon’s earlier point. When you look at a lot of these extension studies, even from clinical trials, 4-, 5-, 6-plus years outpatients are net-losing vision and there’s a lot of theories around why that may be. I think a lot of us think it’s probably the atrophic disease process taking over, but it just goes to show you we have a lot more things we have to take care of. We can’t leave everybody behind. I think we’d all agree with that.
Transcript edited for clarity.