Real-life outcomes of intravitreal injections still poor after first year of treatment
Although improvement of services would be expected over the years, long-term outcomes of intravitreal injections have not changed over the past decade and are suboptimal, according to a big data analysis performed in the U.K.
“This is not a U.K.-specific problem,” Roy Schwartz, MD, said at the virtual Association for Research in Vision and Ophthalmology meeting. Similar studies performed in other countries, including the U.S., show a similar pattern of visual gain in the first year followed by decline thereafter.
The U.K. study was aimed at describing changes in treatment outcomes of patients with neovascular age-related macular degeneration over a period of 10 years, from 2008 to 2018, in 27 U.K. centers. Eyes were grouped by years of treatment initiation, and 3-year outcomes were compared between the groups.
“Overall, about 16,000 eyes of 14,000 patients received 195,104 injections during this time span. Visual acuity over 3 years of follow-up showed a consistent pattern of improvement at 1 year followed by a drop in vision,” Schwartz said.
Similarly, the median number of injections fell sharply from six to seven in year 1 to two to three in year 2 and 3, a trend that did not change through the decade. The visits-to-injections ratio was 2.4 in 2008-2009 and only in 2014-2015 lowered to 2.
“This is still far from what we would expect in an ideal treat-and-extend situation. Though it is difficult to get a clear picture of which treatment patterns were used at each time point, these numbers most closely resemble a PRN regimen, though with a lower number of injections than in the PrONTO trial,” Schwartz said.
Other trends highlighted by the study were better vision at baseline reported over the years and the escalating success of aflibercept after 2013, now the dominant player with about two-thirds of total injections performed.
The drop in the number of injections seems a plausible explanation for the drop in vision and may be due to two reasons, according to Schwartz.
“One reason may be patient compliance. However, it is also possible that, seen the good results after 1 year of treatment, clinicians are less vigilant, resulting in a drop in the number of injections, while our results suggest that frequent injections are also needed after year 1,” he said.
A change in treatment strategy is needed to improve these outcomes, and positive changes may be seen with the introduction of longer-acting therapies, he said.
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Schwartz R, et al. Are we doing better? Impact of treatment paradigm change on neovascular age-related macular degeneration treatment outcomes over the past decade. A big data analysis. Presented at: Association for Research in Vision and Ophthalmology annual meeting; May 1-7, 2021 (virtual meeting).
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