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Frequency of anti-VEGF treatment trends toward extended intervals
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KOLOA, Hawaii – In 2014, the decision to re-treat patients with age-related macular degeneration with anti-VEGF injections will be based on anatomic changes seen on spectral-domain optical coherence tomography, according to a speaker here.
Whether using ranibizumab, bevacizumab or aflibercept,“real-world” treatment intervals will be extended to longer than every 4 weeks based on that data, Elias Reichel, MD, toldcolleaguesat Retina 2014.
Reichel said that “in the real world,” physicians are not dosing their patients monthly and following them monthly for 2 years as was done in the CATT study.
Elias Reichel
“What most physicians are doing is seeing their patients monthly for the first 3 or 4 months, and then the interval changes,” Reichel said.
With disease stability, a “PRN-and-extend” method is used, wherein the frequency of visits is gradually reduced from 4 weeks to 6 weeks and then to 8 weeks, and sometimes longer. The type and location of fluid seen on SD-OCT may help guide treatment, with some types of fluid being more amenable to anti-VEGF therapy than others. For example, early and aggressive reduction of intraretinal fluid with anti-VEGF reduces intraretinal fluid via VEGF-mediated vascular permeability, he said.
“Early identification and management of foveal intraretinal fluid is critical to success,” Reichel said. “There’s less concern about small intraretinal cysts, especially those overlying scars and atrophy. And there’s less concern about residual subretinal fluid and sub-RPE fluid. –by Patricia Nale
Disclosure: Reichel receives royalties from Akorn Pharmaceuticals, Epsilon Instruments and Ocular Instruments; he is a consultant for EMD Serono, Genentech, Perceptive Informatics, ThromboGenics and Valeant Pharmaceuticals; he is on the speakers’ bureau for Regeneron and ThromboGenics; and he has ownership interest in Akorn Pharmaceuticals, Boston Image Reading Center, Hemera Biosciences, NewGen BioPharma, Ophthotech and Panoptica.