Extended anti-VEGF treatment may depend more on patient than dose, administration
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Extending anti-VEGF intervals while maintaining efficacy may depend more on individual patients than the treatment agent or dose, according to a presenter at OSN New York Retina.
“Dosing frequencies may be more about the individual patient factors than anti-VEGF agent or dose level administered,” Jorge A. Fortun, MD, of Bascom Palmer Eye Institute, said.
In a cross-trial comparison of marketed anti-VEGF therapies for neovascular age-related macular degeneration, more than 50% of patients on a true quarterly dosing regimen maintained or gained vision by the end of the trial, Fortun said. In the PIER, EXCITE and CABERNET studies, ranibizumab 0.5 mg was delivered every 12 weeks; in the HAWK and HARRIER studies, brolucizumab 6 mg was delivered every 12 weeks.
In subgroup analysis of the VIEW trial, patients who received “equivalent” quarterly dosing of ranibizumab 0.5 mg or aflibercept 2 mg, as well as patients in the HARBOR trial on a treat-and-extend regimen of 0.5 mg or 2 mg ranibizumab, achieved “robust” mean best corrected visual acuity gains, Fortun said. Increases ranged from 7.8 ETDRS letters to 9.6 ETDRS letters at the end of the studies.
No baseline characteristics predict which patients will respond to an extended dosing interval, Fortun said. The most differentiating parameter in the HAWK and HARRIER trials was retinal thickness at baseline.
Benefits of an extended treatment regimen include lowered treatment burdens and potentially increased efficacy, while carrying the risk of undertreatment, Fortun said.
“There certainly remains a need for identifying alternative approaches to reduce the burden of frequent monitoring for patients who have the potential for extended anti-VEGF dosing,” Fortun said.
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Fortun J. Q12-Q16 Week dosing and beyond: Is it possible and which patients? Presented at: OSN New York and OSN New York Retina; Oct. 17-18, 2020 (virtual meeting).
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