Variants in the APOE gene are associated with improved outcome after anti-VEGF treatment for neovascular AMD

Purpose. Anti-vascular endothelial growth factor (anti-VEGF) drugs have dramatically improved the treatment of neovascular AMD. In pivotal studies, almost 90 of patients maintain vision, with approximately 30 showing significant improvement. Despite these successes, 10 to 15 of patients continue to lose vision, even with treatment. It has been reported that variants in some AMD-associated genes influence treatment outcome. This study showed an association of treatment outcome with variants in the apolipoprotein E (APOE) gene. Methods. One hundred ninety-two patients receiving anti-VEGF treatment for subfoveal choroidal neovascularization secondary to AMD were enrolled. Information on demographics, lesion characteristics, delay until treatment, visual acuity (VA), and number of treatments was collected, and variants of APOE were assessed in all patients at baseline. Best corrected logarithm of the minimum angle of resolution (logMAR) VA was recorded in all patients. Results. The presence of the APOE e4 allele was associated with improved treatment outcome at 3 (P = 0.02) and 12 (P = 0.06) months, compared with the presence of the e2 allele, after adjustment for baseline acuity, treatment delay after first symptoms, age, and sex. Patients with an APOE e4 allele had an odds ratio (OR) of 4.04 (95 confidence interval [CI], 1.11-14.70) for a 2-line gain in vision from baseline at 3 months (P = 0.03) and an OR of 2.54 (95 CI, 0.61-10.52; P = 0.20) at 12 months after treatment, based on multivariate analysis. Conclusions. In patients with neovascular AMD, the presence of the APOE e4 allele conferred significantly better visual outcomes after anti-VEGF treatment than did the e2 allele. These findings suggest a possible role for a personalized approach to treatment with anti-VEGF.