Rajendra S. Apte, MD, PhD

NEW YORK — In a presentation at OSN New York Retina, Rajendra S. Apte, MD, PhD, provides insight on managing macular and retinal diseases in patients with advanced glaucoma.

Rajendra S. Apte, MD, PhD, at Retina 2017.

Rajendra S. Apte, MD, PhD, at Retina 2017.

Rajendra S. Apte, MD, PhD, at Retina 2017.

Rajendra S. Apte, MD, PhD, at Retina 2017.

Sponsorship Statement: This continuing medical education activity is sponsored by

A number of clinical trials have established the efficacy of treating patients with choroidal neovascularization in age-related macular degeneration with anti-angiogenic therapies in a regimented, continuous dosing schedule. More recently, trials now underway are investigating the use of these agents with a PRN, or as-needed, dosing schedule. This article evaluates the evidence to date on whether a continuous dosing schedule or a PRN dosing schedule is the best approach to treating CNV in AMD.

The efficacy of pegaptanib sodium (Macugen, [OSI] Eyetech) in the treatment of neovascular, or wet, AMD was established in the VISION trial (Vascular Endothelial Growth Factor [VEGF] Inhibition Study in Ocular Neovascularization).1 Subsequently, clinical trials including ANCHOR (Anti-VEGF Antibody for the Treatment of Predominantly Classic Choroidal Neovascularization in AMD) and MARINA (Minimally Classic/Occult Trial of the Anti-VEGF Antibody Ranibizumab in the Treatment of Neovascular AMD) showed the effectiveness of ranibizumab (Lucentis, Genentech) in not only delaying the progression of AMD but also improving visual acuity in patients with AMD.2-3 A series of nonrandomized studies demonstrate similar visual acuity improvements in patients treated with intravitreal injections of bevacizumab (Avastin, Genentech).4 Subsequent trials have been designed to explore optimal therapeutic dosing regimens that consider cost-effectiveness, convenience and compliance in addition to efficacy. One dosing consideration is the use of intermittent therapy, which will increase the dosing interval, decrease drug administration and potentially lower the incidence of adverse events, lower overall drug cost and improve patient compliance.