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Antidepressant medication and ocular factors in association with the need for anti-VEGF retreatment in neovascular age-related macular degeneration
  1. Irmela Mantel1,
  2. Marta Zola1,
  3. Olivier Mir2,
  4. Raphael Gaillard3,4,
  5. Francine Behar-Cohen5,6
  1. 1 Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
  2. 2 Department of Ambulatory Care, University Paris Saclay, Villejuif, France
  3. 3 Service de Psychiatrie, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine Paris Descartes, Paris, France
  4. 4 Human Histopathology and Animal Models, Infection and Epidemiology Department, Institut Pasteur, Paris, France
  5. 5 Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland
  6. 6 Inserm U1138, Team 17, From Physiopathology of Ocular Diseases to Clinical Development, Université Paris Descartes Sorbonne Paris Cité, Centre de Recherche des Cordeliers, Paris, France
  1. Correspondence to Dr Irmela Mantel, Jules Gonin Eye Hospital, Lausanne 1002, Switzerland; irmela.mantel{at}


Background/Aims Vascular endothelial growth factor (VEGF) is a key player in the pathogenesis of neovascular age-related macular degeneration (nAMD) and is also involved in the final common pathway of antidepressant medication. This study investigated the relationship between the need for anti-VEGF retreatment in patients with nAMD and antidepressant medication, and the potential impact of ocular structural factors.

Methods Data from two identical prospective 2-year treatment protocols using ranibizumab or aflibercept in a variable-dosing regimen (‘Observe-and-Plan’) were analysed. Retreatment requirement was compared with antidepressant medication intake (primary outcome) and a variety of ocular factors from baseline and from month 3 response (secondary outcomes), using univariate and multivariate analyses.

Results Of the 206 included patients (227 eyes), 19 were on antidepressant medication. Their nAMD eyes significantly more often had pigment epithelium detachment (PED, p=0.04). Multivariate analysis revealed a significant association between anti-VEGF retreatment requirement and antidepressant medication use (p=0.027), as well as thicker central retinal thickness at month 3 (p<0.0001) and month 3 PED height (p=0.001).

Conclusion This study provides evidence that treatment with antidepressant medication increases the anti-VEGF retreatment requirement in patients with nAMD, possibly through the interplay of antidepressant medication, depression status and VEGF levels.

  • angiogenesis
  • degeneration
  • drugs
  • retina
  • medical treatment

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  • RG and FB-C contributed equally.

  • Contributors All authors have significantly contributed to the study and the manuscript. IM: study concept, data acquisition, statistical analysis, manuscript writing. MZ: data acquisition and manuscript writing. OM: pharmacological expertise, manuscript review. RG: study concept, psychiatric expertise, manuscript review. FB-C: study concept, manuscript review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests IM has served as a consultant and/or speaker for Novartis, Bayer and Allergan, and has received writing support for an independent article from Novartis. OM has acted as consultant for Amgen, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Merck, Novartis, Pfizer, Roche and Servier. RG has received compensation as a member of the scientific advisory board of Janssen, Lundbeck, Roche and Takeda. He has served as consultant and/or speaker for AstraZeneca, Pierre Fabre, Lilly, Otsuka, Sanofi and Servier and received compensation, and he has received research support from Servier.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the local ethics committee (Ethics Committee Vaud, Switzerland) and was performed according to the ethical standards set by the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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