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Anti-VEGF injection regimen for AMD still unclear, speaker says
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PARIS — Although the largest trials on anti-VEGF therapy in age-related macular degeneration have shown that best possible outcomes are obtained with monthly injections, doubts remain on whether this fixed-dosing regimen is suitable for all patients, according to one speaker here.
"There are patients who had a stable improvement with just one injection, and about 20% of the patients do not require further injections after the 3-month loading phase," Frank Holz, MD, said at the Euretina meeting preceding the European Society of Cataract and Refractive Surgeons meeting.
"There is a huge variability to drug response and we do have to prevent overdosing and risk of complications such as endophthalmitis," he said.
In addition, in a real-life scenario, monthly visits are difficult to comply with and entail high costs, he said.
The German WAVE study, which was based on real-life outcomes of a fixed monthly regimen, showed that the loading phase went well; but then, for a number of reasons, patient attendance to the clinic was erratic.
"The average number of injections was very low and definitely not sufficient to achieve good results. Eventually, we lost vision over time," Dr. Holz said.
"Although there should be a consensus on guidelines for treatment, there are tremendous discrepancies on the best regimen for anti-VEGF therapy," he said. "We do not have the final answer on when to inject."