Predicting Non-response to Ranibizumab in Patients with Neovascular Age-related Macular Degeneration

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Title:	Predicting Non-response to Ranibizumab in Patients with Neovascular Age-related Macular Degeneration
Author(s):	Asten, F. van; Rovers, M.M. ; Lechanteur, Y.T.E.; Smailhodzic, D. ; Muether, P.S.; Chen, J.; Hollander, A.I. den ; Fauser, S.; Hoyng, C.B. ; Wilt, G.J. van der ; Klevering, B.J.
Publication year:	2014
Source:	Ophthalmic Epidemiology, vol. 21, iss. 6, (2014), pp. 347-355
ISSN:	0928-6586
DOI:	http://dx.doi.org/10.3109/09286586.2014.949010
Publication type:	Article / Letter to editor
Please use this identifier to cite or link to this item : http://hdl.handle.net/2066/137535
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Subject:	Radboudumc 12: Sensory disorders RIHS: Radboud Institute for Health Sciences Radboudumc 12: Sensory disorders RIMLS: Radboud Institute for Molecular Life Sciences Radboudumc 13: Stress-related disorders DCMN: Donders Center for Medical Neuroscience Radboudumc 15: Urological cancers RIHS: Radboud Institute for Health Sciences
Organization:	Health Evidence Operating Rooms Ophthalmology Human Genetics
Journal title:	Ophthalmic Epidemiology
Volume:	vol. 21
Issue:	iss. 6
Page start:	p. 347
Page end:	p. 355
Abstract:	Abstract Purpose: To validate known and determine new predictors of non-response to ranibizumab in patients with neovascular age-related macular degeneration (AMD) and to incorporate these factors into a prediction rule. METHODS: This multicenter, observational cohort study included 391 patients treated with ranibizumab for neovascular AMD. We performed genetic analysis for single nucleotide polymorphisms in AMD-associated genes and collected questionnaires regarding environmental factors and disease history. The primary outcome was non-response to treatment, defined as a loss of visual acuity >/=30% of letters. Results : Of the 391 patients, 47 were classified as non-responsive. Independent predictors for non-response were age, baseline visual acuity, diabetes mellitus and accumulation of risk alleles in the CFH, ARMS2 and VEGF-A genes. The area under the receiver operating characteristic curve was 0.77 (95% confidence interval 0.70-0.84). We derived a clinical prediction rule, with possible total risk scores ranging from 0-19 points. The absolute risk of non-response varied from 3-52% between risk score groups. CONCLUSION: This is an important step towards a clinical prediction rule that can aid clinicians in identifying AMD patients with increased likelihood of non-response, and consequently contribute to making shared treatment decisions.