Treat-and-Extend Regimen of Anti-VEGF Proves Effective, Reduces Burden for AMD

July 22, 2018

At the final follow-up in year 5, 16.5% of eyes had lost >15 ETDRS letters, compared to 33% that had gained >15 ETDRS letters.

Micaela M. Koci, BS, BA

The use of treat-and-extend regimens with anti-vascular endothelial growth factor (anti-VEGF) agents proved to be effective for achieving visual improvements in patients with neovascular age-related macular degeneration (nAMD).

The 5-year, real-world outcomes of the retrospective analysis revealed that the treat-and-extend regimens of aflibercept (Eylea, Regeneron), ranibizumab (Lucentis, Genentech), or bevacizumab (Avastin, Genentech) resulted in decreased treatment burden compared to monthly or fixed bimonthly dosing.

While the authors noted that “to reduce overall treatment burden, the treat-and-extend regimen may be an effective treatment option for patients,” they did acknowledge that further examinations are needed to confirm the findings.

Presented by Micaela M. Koci, BS, BA, an ophthalmology technician at the University of Nevada Reno School of Medicine at the American Society of Retina Specialists (ASRS) annual meeting in Vancouver, British Columbia, the data included 212 eyes from 183 patients with nAMD who were treatment naïve. All patients were treated by a single physician at a single site for ≥1 year, with a mean follow-up time of 3.3 (median, 3) years. Patients were an average of 79.6 (standard deviation [SD], 8.9) years old (59% female).

In total, 212 eyes completed 1 year of follow up, while 205 completed 2 years, 149 completed 3 years, 85 completed 4 years, and 51 completed 5 years. Baseline best-corrected visual acuity (BCVA) was 51 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, based on the equivalence to a Snellen BCVA score of 20/100. This was recognized as a limitation of the study by the authors, as actual ETDRS was not measured.

Results revealed the mean BCVA increases at years 1, 2, 3, 4, and 5 w­­ere 9.5 (SD, 22.9) letters, 7.9 (SD, 26.8) letters, 6.7 (SD, 28.8) letters, 4.9 (SD, 26.2) letters, and 7.1 (SD, 30.5) letters, respectively. The average number of injections administered to each patient in each year was 7 in the first year, 5 in the second, third, and fourth years, and 4 in the fifth year.

At the final follow-up, a smaller percentage—16.5% (n = 35)—of eyes had lost >15 ETDRS letters compared to 33% (n = 70) that had gained >15 ETDRS letters. “The treat-and-extend regimen was effective in achieving visual improvements in patients with nAMD for up to 5 years of treatment with an overall decrease in [the] number of injections per year,” Koci and colleagues wrote.

The study, “Retrospective Evaluation of Neovascular Age-Related Macular Degeneration Managed With Treat-and-Extend Regimen: 5-Year Results of the RENO Study,” was presented as a poster at ASRS’s 36th annual meeting.

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