CANTREAT Results Show Treat-and-Extend Benefits Versus Once-Monthly for AMD


Though the 2 dosing regimens had comparable visual acuity improvements over 24 months, patients given ranibizumab once-monthly received treatment nearly 6 more times on average.

Patient with neovascular age-related macular degeneration (nAMD) could significantly improve best corrected visual acuity (BVCA) through a treat-and-extend (T&E) regimen of ranibizumab.

The 24-month post-authority CANTREAT study, presented at the American Society of Retina Specialists (ASRS) Annual Meeting in Vancouver, BC, showed T&E dosing may be an improved regimen scheduled for patients versus once-monthly dosing over a 12-month treatment span.

Study author Peter Kertes, MD, CM, ophthalmologist-in-chief of The John and Liz Tory Eye Center at Sunnybrook Health Sciences Center, and professor of ophthalmology and vision sciences at the University of Toronto, told MD Magazine® that T&E has emerged as “overwhelmingly, the most common treatment paradigm” among AMD patients.

“Patients are treated until they have disease stability, and then we try to extend the interval as long as we can, so patients don’t have to come as often as they otherwise would need to,” Kertes said.

Despite this, little clinical evidence supporting the regimen practice exists. Kertes and colleagues conducted a prospective, randomized, open-label study across multiple health centers in Canada, testing both T& E and monthly regimen in treatment-naïve patients with nAMD. Researchers assessed patient group differences with the one-sided independent Sample t-test for change in BCVA.

The study included 580 patients, split 1:1 to T&E (n= 287) and OM (n= 293) ranibizumab. Among them, 526 patients (268, 258, respectively) participated in 12- and 24-month follow-up analysis. Mean patient age was 78.8 years, with 60.3% of the population being female and 94.3% Caucasian. Researchers noted no significant differences in baseline characteristics.

Mean baseline BCVA was similar across the 2 regimen groups: 58.7 for T&E patients, and 59.4 for once-monthly patients. At 12 months, T&E patients had averaged 9.4 ranibizumab injections, while once-monthly patients averaged 11.8. The former patient group averaged a BCVA improvement of 8.4 letters, compared to 6.0 letters in the latter group (P = 0.012).

At 24 months, T&E patients had been administered an average of 18.0 injections, compared to 23.6 average injections by once-monthly patients. BVCA improvement was more comparable: T&E patients averaged an improvement of 6.4 letters, and once-monthly patients averaged an improvement of 7.0 letters (P = 0.336). Among T&E patients, 69.3% and 70.9% were extended to ≥8 weeks of treatment at 12 and 24 months, and 29.9% and 40.0% were extended to 12 weeks at 12 and 24 months, respectively.

Though patient BVCA improvement was comparable at 24 months among patient groups, researchers noted that T&E patients were subjected to significantly fewer injections than once-monthly patients. Current evidence suggests that more treatment is better, Kertes said. But that may not always be the case.

“Macular degeneration is probably a spectrum of disease, and people with more severe disease need more frequent injections, and those with different types of macular degeneration probably need less,” Kertes said. “I think a dosing regimen like treat-and-extend allows you to personalize treatment to patient’s needs.”

That personalization is particularly critical for the AMD patient population, which is mostly comprised of older patients who have limited access to their physicians.

The study, "Canadian Treat-and-Extend Analysis Trial With Ranibizumab in Patients With Neovascular AMD: CANTREAT Study 1-Year Results," was presented at ASRS 2018 on Saturday.

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