Triple therapy reduces treatment burden for wet AMD in anti-VEGF nonresponders

A three-part treatment protocol involving injections of triamcinolone and bevacizumab followed by short-duration photodynamic therapy stabilized vision and reduced the re-treatment burden in patients with neovascular age-related macular degeneration who did not respond to initial anti-VEGF therapy, a retrospective study found.

Allan Franklin, MD, and colleagues in Pensacola, Fla., reviewed outcomes for 27 patients treated with the triple therapy. They presented their results in a poster at the American Society of Retina Specialists annual meeting.

The treatment protocol involved combined injections of triamcinolone acetonide and Avastin (bevacizumab, Genentech). Surgeons then performed short-duration PDT with Visudyne (verteporfin, Novartis/OLT) within 2 weeks after the injections, according to the study.

At 1 year follow-up, investigators found that approximately 40% of patients required one re-treatment with a combination intravitreal injection, and 11% required two to three combination injections or repeated triple therapy. Additionally, 11% of patients required three or more re-treatments and were considered refractory to triple therapy, the authors reported.

Overall, patients showed a stabilization in vision during the first 12 months of follow-up.

Among 14 patients followed for longer than 1 year, three patients gained at least three lines of vision, three patients lost three lines or more and vision remained stabilized in eight patients, according to the study.

At 12 months follow-up, central foveal thickness had significantly decreased by an average of 70 µm to 75 µm (P < .05), the authors noted.

"Although specific timing and components of triple therapy have yet to be optimized, this treatment appears to be a viable option with a diminished treatment burden to frequent anti-VEGF intravitreal injections to patients who are not rapid responders to anti-VEGF therapy," they said.