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Evaluation of the First-Dose Anti-VEGF Anatomical Response in Polypoidal Choroidal Vasculopathy Patients: Correlation
Yuelin Wang1,2, Wenfei Zhang3,4, Jingyuan Yang3,4
1Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China, violin95@qq.com.
Insights
First-dose response in polypoidal choroidal vasculopathy (PCV) patients treated with conbercept predicts third-dose outcomes. Different patient factors influence early treatment response in PCV subtypes.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Medical Interventions
Background:
- Polypoidal choroidal vasculopathy (PCV) is a significant cause of vision loss.
- Understanding early treatment response is crucial for managing PCV.
Purpose of the Study:
- To determine if initial response to conbercept predicts later anatomical response in PCV.
- To identify risk factors associated with the first-dose response in PCV patients.
Main Methods:
- Retrospective analysis of 165 PCV patients receiving intravitreal conbercept (IVC).
- Evaluation of response correlations and risk factors based on pachy-PCV and non-pachy-PCV phenotypes.
- Assessment of changes in central macular thickness (CMT) and best-corrected visual acuity (BCVA).
Main Results:
- A significant correlation was found between first- and third-dose anatomical response in both PCV subtypes.
- Baseline CMT predicted first-dose response in pachy-PCV (AUC=0.847).
- Baseline BCVA, CMT, PED height, intraretinal fluid, and PED diameter influenced first-dose response in non-pachy-PCV (AUC=0.940).
- Good first-dose responders showed significant CMT reduction and BCVA improvement after the third injection.
Conclusions:
- First-dose efficacy is a reliable predictor of third-dose anatomical response in PCV patients treated with IVC.
- Subtype-specific factors influence the initial response to conbercept in PCV.
Introduction:
The aims of the study were to investigate whether first-dose efficacy can predict third-dose anatomical response and analyze the risk factors for first-dose response of polypoidal choroidal vasculopathy (PCV) patients.
Methods:
We retrospectively reviewed patients' medical records from 27 centers of China PCV Research Alliance. PCV patients treated with intravitreal injections of conbercept (IVC) based on the 3+ pro re nata regimen (three initial monthly injections, followed by injections as needed) with complete 3-month injection data were included. Response correlations, risk factor associations, changes in central macular thickness (CMT) or best-corrected visual acuity (BCVA), and number of injections in the first year of follow-up were evaluated separately in the pachy-PCV and non-pachy-PCV phenotypes.
Results:
Overall, 165 eligible patients were included. There was a significant correlation between first-dose and third-dose anatomical response in pachy-PCV or non-pachy-PCV patients (rs = 0.611, p < 0.001; rs = 0.638, p < 0.001). Multivariate analysis revealed associations of good first-dose anatomical response in pachy-PCV patients with baseline CMT with a predicted area under the curve (AUC) of 0.847, while a good response in non-pachy-PCV patients was associated with baseline BCVA, baseline CMT, pigment epithelial detachment (PED) height, higher proportion of intraretinal fluid, and lower PED minimum diameter with a predicted AUC of 0.940. CMT in the good first-dose response group was significantly decreased from baseline at all first-year follow-up visits in both groups (p < 0.001), and mean BCVA was improved in the good versus poor first-dose anatomical response group (5.4 vs. 1.6 ETDRS letters in pachy-PCV, 10.6 vs. 7.4 letters in non-pachy-PCV) after the third injection. No significant difference was observed in the number of injections in the first year of follow-up between different response groups.
Conclusion:
In PCV patients receiving IVC, the first- and third-dose responses are significantly correlated, and different factors influence the first-dose response in different subtypes of PCV.
