AMD patients undermonitored, undertreated in real-world scenarios, observational study shows

COPENHAGEN, Denmark — An observational study conducted at several locations in Europe, Australia, Canada and Venezuela showed that, in a real-world scenario, treatment with ranibizumab for wet age-related macular degeneration had poorer-than-expected visual outcomes due to irregular monitoring and a low number of treatments per year.

"In clinical practice, as-needed or treat-and-extend dosing regimens are generally adopted, but on the whole they don’t seem to produce good results," Sobha Sivaprasad, MD, said at the meeting of the European Society of Ophthalmology.

Sobha Sivaprasad

The AURA study included 2,671 patients and investigated the real-world utilization and related outcomes of anti-VEGF therapy over 2 years.

Overall, 9.8 visual acuity tests were performed over the study duration, and patients received a mean of five injections in the first year and two injections in the second year. In all countries, mean visual acuity increased from baseline during the first 3 months, but the initial gain was only maintained by the end of year 1 in the U.K., where injection frequency was the highest and visual acuity and optical coherence tomography monitoring occurred almost monthly.

"What emerges is a distinct pattern of systematic undertreatment of patients with wet AMD with the PRN dosing regimen," Sivaprasad said.

Reasons for failure to comply with official recommendations for as-needed treatment might be health-system related, such as problems with reimbursement and scheduling appointments in overloaded hospitals, but also patient- and physician-dependent, she said.

Disclosure: Sivaprasad has received travel grants and research grants from and attended advisory board meetings for Pfizer, Novartis and Allergan.