Association of Patient Age with Response to Anti-Vascular Endothelial Growth Factor Agents for Treatment of Diabetic Macular Edema

Summary

DRCR Protocols I, T and AC: Older age associated with less VA improvement and central subfield thick response in anti-VEGF therapy.

Abstract

Purpose: Explore the association of patient baseline age with response to anti-vascular endothelial growth factor treatment for diabetic macular edema.

Methods: One thousand six eyes assigned to anti-vascular endothelial growth factor treatment in 3 DRCR Retina Network randomized trials for diabetic macular edema were included. Age was classified into four levels: younger than 50, 50 to 59, 60 to 69, and 70 years or older. The associations between age with change in visual acuity and central subfield thickness from baseline and with weak treatment response in visual acuity and central subfield thickness not meeting prespecified thresholds over 2 years were assessed, controlling for trial, anti-vascular endothelial growth factor agent, and potential confounders.

Results: At 2 years, the average improvement from baseline decreased with older age for visual acuity (youngest to oldest: +17.9 to +9.0 letters; P < 0.001) and central subfield thickness (-183 µ m to -158 µ m; P = 0.02). The cumulative proportion of weak response in visual acuity (60%-84%; P < 0.001) and central subfield thickness (42%-62%; P = 0.009) increased with older age. These trends were present in all anti-vascular endothelial growth factor subgroups.

Conclusion: Less improvement from baseline and a greater likelihood of weak treatment response in visual acuity and central subfield thickness were observed among older patients. These findings may help refine expectations of treatment outcomes when initiating anti-vascular endothelial growth factor therapy for diabetic macular edema.