This article is more than 5 years old. Information may no longer be current.
Treat-and-extend AMD regimen sustains outcomes for up to 3 years
Click Here to Manage Email Alerts
A treat-and-extend protocol improved vision and reduced retinal thickness for up to 3 years in patients with neovascular age-related macular degeneration, according to study findings.
The retrospective study included 212 eyes of 189 patients with treatment-naïve neovascular AMD treated with Lucentis 0.5 mg/0.05 mL (ranibizumab, Genentech) or Avastin 1.25 mg/0.05 mL (bevacizumab, Genentech) for at least 1 year under a treat-and-extend regimen.
Patients received monthly intravitreal injections until no signs of choroidal neovascularization (CNV) were identified.
Treatment was extended by intervals of 2 weeks, provided no signs of CNV were seen. If signs of intraretinal or subretinal fluid or macular hemorrhage were seen, treatment intervals were reduced by 2 weeks. Mean follow-up was 1.88 years.
Patients received an average of 7.6 injections at 1 year, 5.7 injections at 2 years and 5.8 injections at 3 years.
Mean best corrected visual acuity improved significantly, from 20/139 at baseline to 20/79 at 1 year, 20/69 at 2 years and 20/64 at 3 years, according to the researchers.
In addition, 94% of eyes had lost fewer than three lines of BCVA, and 34.4% had gained at least three lines at the final postoperative examination.
Mean central retinal thickness decreased significantly, from 351 μm at baseline to 285 µm at 1 year, 275 µm at 2 years and 276 µm at 3 years.
At 3 years, 52.5% of patients had signs of CNV activity.
Disclosure: See the study for a full list of all authors’ relevant financial disclosures.
Perspective
Back to Top
Andrew P. Schachat, MD
Rayess and colleagues reported on 3-year outcomes from a retrospective study of about 200 patients with neovascular age-related macular degeneration managed with a treat-and-extend regimen utilizing either Lucentis (ranibizumab, Genentech) or Avastin (bevacizumab, Genentech). The “registration trials” showed that ranibizumab and Eylea (aflibercept, Regeneron) were safe and effective for the management of wet AMD used monthly (ranibizumab) or monthly followed by every-2-months (aflibercept) protocols. So-called PRN, or “as needed,” strategies were shown to be effective in the CATT, IVAN and other similar trials. However, most retina specialists favor the treat-and-extend (T and E) approach.
According to the 2014 American Society of Retina Specialists “Preferences and Trends” survey, about 78% of U.S. retina specialists and 56% of international retina specialists use the T and E approach. About 2% of US retina specialists see and treat monthly, 16% see monthly and treat if there is activity (PRN) and about 4% use some other strategy. In the Rayess report, the mean acuity change was +12 letters at 1 year, +11 at 2 years and +14 letters at 3 years, but the number of subjects followed at 2 or 3 years was low. A recent prospective randomized trial, the LUCAS study, also tested the T and E approach; the outcome was about +8 letters at 1 year for both ranibizumab and bevacizumab. There is now accumulating evidence in the literature to support the preferences for the T and E approach voiced in the ASRS survey.
Click Here to Manage Email Alerts