Year 2 efficacy results of 2 randomized controlled clinical trials of pegaptanib for neovascular age-related macular degeneration

VEGF Inhibition Study in Ocular Neovascularization … - Ophthalmology, 2006 - Elsevier
VEGF Inhibition Study in Ocular Neovascularization (VISION) Clinical Trial Group
Ophthalmology, 2006Elsevier
OBJECTIVE: To evaluate the efficacy of a second year of pegaptanib sodium therapy in
patients with neovascular age-related macular degeneration (AMD). DESIGN: Two
concurrent, multicenter, randomized, double-masked, sham-controlled studies (VISION
[Vascular Endothelial Growth Factor Inhibition Study in Ocular Neovascularization] trials).
PARTICIPANTS: Patients with all angiographic neovascular lesion compositions of AMD
were enrolled. In combined analyses, 88%(1053/1190) were re-randomized at week 54, and …
OBJECTIVE
To evaluate the efficacy of a second year of pegaptanib sodium therapy in patients with neovascular age-related macular degeneration (AMD).
DESIGN
Two concurrent, multicenter, randomized, double-masked, sham-controlled studies (V.I.S.I.O.N. [Vascular Endothelial Growth Factor Inhibition Study in Ocular Neovascularization] trials).
PARTICIPANTS
Patients with all angiographic neovascular lesion compositions of AMD were enrolled. In combined analyses, 88% (1053/1190) were re-randomized at week 54, and 89% (941/1053) were assessed at week 102.
INTERVENTIONS
At week 54, those initially assigned to pegaptanib were re-randomized (1:1) to continue or discontinue therapy for 48 more weeks (8 injections). Those initially assigned to sham were re-randomized to continue sham, discontinue sham, or receive 1 of 3 pegaptanib doses.
MAIN OUTCOME MEASURES
Mean change in visual acuity (VA) over time and mean change in the standardized area under the curve of VA and proportions of patients experiencing a loss of ≥15 letters from week 54 to week 102; losing <15 letters (responders) from baseline to week 102; gaining ≥0, ≥1, ≥2, and ≥3 lines of VA; and progressing to legal blindness (20/200 or worse).
RESULTS
In combined analysis, mean VA was maintained in patients continuing with 0.3-mg pegaptanib compared with those discontinuing therapy or receiving usual care. In patients who continued pegaptanib, the proportion who lost >15 letters from baseline in the period from week 54 to week 102 was half (7%) that of patients who discontinued pegaptanib or remained on usual care (14% for each). Kaplan–Meier analysis showed that patients continuing 0.3-mg pegaptanib for a second year were less likely to lose ≥15 letters than those re-randomized to discontinue after 1 year (P<0.05). The proportion of patients gaining vision was higher for those assigned to 2 years of 0.3-mg pegaptanib than receiving usual care. Progression to legal blindness was reduced for patients continuing 0.3-mg pegaptanib for 2 years.
CONCLUSIONS
Continuing visual benefit was observed in patients who were randomized to receive therapy with pegaptanib in year 2 of the V.I.S.I.O.N. trials when compared with 2 years’ usual care or cessation of therapy at year 1.
Elsevier