Treat-and-extend therapy a popular, cost-effective approach to treating neovascular AMD

Issue: March 10, 2011

PHILADELPHIA — Utilizing a treat-and-extend treatment regimen for bevacizumab and ranibizumab therapy proved visually efficacious as well as time- and cost-efficient among patients with neovascular age-related macular degeneration, a speaker said here.

While visual outcomes and recurrence rates were similar for patients who received Lucentis (ranibizumab, Genentech) or Avastin (bevacizumab, Genentech), bevacizumab therapy cost less, Omesh P. Gupta, MD, MBA, said at Macula 2011.

Dr. Gupta presented data from 166 eyes of 159 patients in a retrospective case series comparing visual outcomes, number of injections and medical costs of therapy in patients who received ranibizumab or bevacizumab. Mean follow-up was 1.5 years.

"In terms of exudative recurrence, anywhere from 45% to 52% of patients had no recurrence over the course of study," Dr. Gupta said, referring to treatment with both anti-VEGF agents.

Patients were treatment-naïve at the start of therapy and received monthly injections until seen as "dry" on ocular coherence tomography assessment. Treatment intervals were extended by 2 weeks at a time unless exudation was seen on OCT.

Visual outcomes were similar between the two arms of the study. At 1 year, 32% to 35% of patients gained at least three lines. The mean period of extension between the two arms was statistically significant, Dr. Gupta said, with bevacizumab treatments extending longer.

To evaluate the economic impact of therapy, medical costs for patients in the study were compared to medical costs for patients in the phase-3 MARINA, ANCHOR and PrONTO clinical trials.

The treat-and-extend regimen was linked to significantly fewer patient visits, fewer injections and lower medical costs compared to all phase-3 trials.

Mean number of injections and overall cost were greater in the ranibizumab group, Dr. Gupta said.

"Significant cost savings can be achieved with treating patients with bevacizumab compared to ranibizumab," he said.

Disclosure: Dr. Gupta has no relevant financial interest to disclose.

The paper by Gupta and colleagues at the Macula 2011 meeting in Philadelphia is the largest treat-and-extend (TER) experience presented to date and encompasses both ranibizumab and bevacizumab use for new-onset (treat-naïve) neovascular AMD. The study was performed on the Retina Service of Wills Eye Institute and, although limited by its retrospective nature, the patient baseline characteristics were similar to those in the large, pivotal MARINA and ANCHOR ranibizumab phase 3 studies. The results show that the efficacy profile for both ranibizumab and bevacizumab with this TER approach were comparable to the monthly ranibizumab as performed in the pivotal trials but with a lower burden of office visits, injections, and cost. Furthermore, the mean number of injections in the second year of follow-up was lower than in the first year. Overall, this study supports the notion that individualizing neovascular AMD treatment in this fashion with either anti-VEGF agent appears to be a safe and effective alternative to both monthly treatment and PRN regimens in which patients are followed monthly and treated only for signs of active exudation.

– Carl D. Regillo, MD
OSN Retina/Vitreous Board Member
Disclosure: Dr. Regillo is director of Wills Eye Retina Research. He is a consultant for and receives grant/research support from Genentech.