Algorithm designed to guide treat-and-extend anti-VEGF dosing

A new algorithm may be used to tailor treat-and-extend regimens with intravitreal anti-VEGF agents to individual patients with retinal disease, according to a study.

The algorithm was developed using data from 11 published studies on treat-and-extend regimens with intravitreal Avastin (bevacizumab, Genentech) Lucentis (ranibizumab, Genentech) and Eylea (aflibercept, Regeneron).

The treat-and-extend approach used in most of the studies involved a 3-month loading phase until no fluid was detected on OCT, followed by 2-week extension intervals up to 10 weeks to 12 weeks unless there was a recurrence of fluid or hemorrhage.

The algorithm is applicable to wet age-related macular degeneration, macular edema secondary to retinal vein occlusion and diabetic macular edema.

Using the algorithm, a consensus panel determined that treatment intervals can be extended if there is continued absence or stabilization of subretinal fluid or intraretinal fluid for at least two consecutive injections and no new hemorrhage.

“The consensus panel agreed that treatment can be extended by up to 2 weeks at a time if the disease remains stable,” the study authors said. “The ‘standard’ maximum extension period was considered to be 12 weeks; however, this may also depend on the nature of the disease being treated, for example, shorter for [neovascular] AMD compared with DME or ME/RVO, monocular patients, eyes at high risk and the drug being used.”

Data did not show a strong association between overtreatment with anti-VEGF agents and increased risk of geographic atrophy. – by Matt Hasson

Disclosure: Freund reports he is a consultant for Genentech, Bayer, Regeneron, ThromboGenics and Heidelberg Engineering.

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Source:

Freund KB, et al. Retina. 2015;doi:10.1097/IAE.0000000000000627.