Treat-and-extend offers significant improvements vs. as-needed schedule

VIENNA, Austria — Results of a study carried out in a Swiss clinic showed improved outcomes following anti-VEGF therapy with a treat-and-extend approach compared with a previous as-needed regimen, according to a presenter here.

“We switched to treat-and-extend in February 2012 for both treatment-naïve patients and for those previously treated with as-needed,” Christian Pruente, MD, said at the Advanced Retinal Therapy meeting.

Christian Pruente

One-year results in a group of 146 patients showed improved efficacy, stability and more consistent results with significantly reduced intra-individual variation, according to Pruente.

Patients received monthly injections until stabilization of best corrected visual acuity and OCT parameters at three consecutive visits. When stable, the treatment and visit interval was extended by 2 weeks, with a maximum interval of 3 months. In case of new activity, the interval was shortened by 4 weeks, which became 2 if new activity appeared twice. Injection was administered at every visit, independent of activity.

“Results of switch-over patients showed that the previous as-needed regimen allowed an initial gain of vision followed by significant loss,” Pruente said. “When switched to treat-and-extend, patients regained vision, going back to the maximum gain, and remained stable. In treatment-naïve patients, BCVA and central retinal thickness underwent stable improvement.”

The mean number of injections was 8.6 compared with 5.6 for the previous as-needed approach, whereas the number of visits and intervals between visits were reduced by approximately 50%, according to Pruente.

Pruente concluded that treat-and-extend allowed for strict control of disease activity with reduced burden for patient and clinic.

“The more regular and definite schedule makes internal organization easier and improves patient compliance,” he said.

Disclosure: Pruente is a consultant to Alcon, Allergan, Bayer, Griesshaber and Novartis.