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Speaker offers highlights of Euretina guidance on management of AMD
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HAMBURG — A preview of the updated Euretina guidance on age-related macular degeneration, a consensus document provided by leading European experts based on the findings of major clinical trials, was presented at the Euretina meeting before publication.
Ursula Schmidt-Erfurth, MD, shared with the audience the good news of the substantially decreased rate of AMD-related legal blindness since the advent of anti-VEGF therapy.
Ursula Schmidt-Erfurth
“AMD is now successfully controlled. However, improvement is related to repeated, continuous lifetime treatment, which also reflects in a constantly increasing burden on healthcare systems,” she said.
Guidance is necessary, to optimize the continuous and constantly growing cycle of diagnosis, treatment, follow-up and retreatment, “because, in spite of being rotating like hamsters in the wheel, we are still undertreating and undermonitoring patients,” she said.
Taking into account the latest findings of the HARBOR study, the Euretina guidance recommends the use of ranibizumab with both the monthly and as-needed regimen with monthly monitoring. Bevacizumab in the CATT trial has shown best improvement with monthly administration.
“PRN is not clinically equivalent. Nevertheless , use the cheaper drug in a tighter regimen is a possibility,” Schmidt- Erfurth said.
The safety concerns raised by the CATT trial should not be underestimated, as well as the potential additional adverse events related to the preparation of the drug in single doses, she said.
The last player on the ground, aflibercept, is highly promising and showing even better results than ranibizumab.
Fluorescein angiography is still considered mandatory for primary diagnosis and advisable in case of unexplained vision loss or lack of morphologic response.
“Finally, OCT is the indispensable tool for screening and follow up monitoring. Morphological changes are key in the decision-making process to avoid undertreatment but also not offer overtreatment,” Schmidt-Erfurth said.
Disclosure: Schmidt Erfurth is a consultant for Allergan, Alcon, Bayer HealthCare, Boehringer and Novartis.