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Original Article| Volume 58, ISSUE 2, P82-89, April 2023

Subfoveal choroidal thickness as a potential predictor of treatment response after intravitreal ranibizumab injections for polypoidal choroidal vasculopathy

Published:October 19, 2021DOI:https://doi.org/10.1016/j.jcjo.2021.09.008

      Abstract

      Objective

      To evaluate the impact of subfoveal choroidal thickness (SFCT) and other clinical biomarkers in intravitreal anti-vascular endothelial growth factor response in treatment-naive Caucasian patients diagnosed with polypoidal choroidal vasculopathy (PCV/AT1).

      Design

      Cross-sectional study.

      Participants

      Treatment-naive patients diagnosed with PCV/AT1 recruited in a single centre from January 2013 to December 2020.

      Methods

      Eligibility was determined in treatment-naive PCV patients who received a loading dose of 3 injections of 0.5 mg ranibizumab. A diagnosis of PCV/AT1 was made based on the diagnostic criteria in the efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with sumptomatic macular polypoidal choroidal vasculopathy study. Choroidal thickness was manually measured by enhanced depth imaging technology in Spectralis spectral domain optical coherence tomography.

      Results

      Eighty-three eyes of 83 patients were included in this study, 47 patients diagnosed with PCV/AT1 with a good response to 3 intravitreal injections of ranibizumab and 36 with a poor response. The receiver operating characteristic curve of treatment effect against the SFCT revealed that the area under the curve was 0.85 (range, 0.74–0.96). Based on the Youden index, the optimal SFCT cut-off point for predicting a poor response to anti-vascular endothelial growth factor is 257 µm. In the multivariate analysis, the SFCT remained statistically significant (odds ratio 1.02 [range, 1.01–1.04]; P = 0.008). The combined effect of treatment effect against clinical biomarkers produced an area under the curve of 0.90 (range, 0.82–0.98).

      Conclusion

      SFCT is a risk factor for a poor response to the 3 loading injections of ranibizumab in treatment-naive PCV/AT1 Caucasian patients. A cut-off point of 257 µm could be a valuable parameter for defining the population at risk for an inadequate response to ranibizumab.

      Objectif

      Évaluer l’épaisseur choroïdienne sous-fovéale (ECSF) et d'autres biomarqueurs cliniques de la réponse à l'administration intravitréenne d'un anti-VEGF (facteur de croissance endothélial vasculaire) à des patients caucasiens jamais traités qui ont fait l'objet d'un diagnostic de vasculopathie polypoïdale choroïdienne (VPC, ou « dilatation anévrysmale type 1 » [AT1]).

      Nature

      Étude transversale.

      Participants

      Patients jamais traités qui ont fait l'objet d'un diagnostic de VPC/AT1 dans un établissement unique, recrutés entre janvier 2013 et décembre 2020.

      Méthodes

      On a déterminé l'admissibilité de patients jamais traités auxquels on a administré une dose d'attaque de 3 injections de 0,5 mg de ranibizumab. Le diagnostic de VPC/AT1 reposait sur les critères diagnostiques retenus dans le cadre de l’étude sur l'efficacité et l'innocuité de la thérapie photodynamique à la vertéporfine, administrée en association avec le ranibizumab ou en monothérapie vs le ranibizumab en monothérapie, chez des patients présentant une vasculopathie polypoïdale choroïdienne maculaire symptomatique. L’épaisseur choroïdienne a été mesurée manuellement à l'aide de la tomographie par cohérence optique (OCT) en domaine spectral à l'imagerie à profondeur améliorée réalisée sur la plateforme Spectralis.

      Résultats

      Ainsi, 83 yeux de 83 patients ont été admis à cette étude : 47 patients atteints de VPC/AT1 qui ont eu une bonne réponse à la suite de l'administration de 3 injections intravitréennes de ranibizumab et 36 patients qui ont eu une réponse médiocre au même traitement. Selon la courbe caractéristique de la performance de l'effet du traitement sur l'ECSF, l'aire sous la courbe était de 0,85 (fourchette : 0,74–0,96). D'après l'indice de Youden, le seuil optimal de l'ECSF permettant de prédire une réponse médiocre à l'administration d'un anti-VEGF se situe à 257 µm. Lors de l'analyse multivariée, l'ECSF est demeurée statistiquement significative (rapport de cotes : 1,02 [fourchette : 1,01–1,04]; p = 0,008). L'effet combiné du traitement ainsi que des biomarqueurs cliniques a donné lieu à une aire sous la courbe de 0,90 (fourchette : 0,82–0,98).

      Conclusion

      L'ECSF représente un facteur de risque de réponse médiocre au traitement d'attaque reposant sur 3 injections de ranibizumab chez des patients caucasiens jamais traités atteints de VPC/AT1. Un seuil de 257 µm représente un paramètre très utile pour identifier les sujets chez lesquels le ranibizumab risque d'avoir un effet médiocre.
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