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Niro Narendran, Randhir Chavan, Swathi Panneerselvam, Yit Yang; Impact of using the aflibercept dosing regimen for wet macular degeneration on numbers of injections and monitoring visits over three years. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3813.
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To model the three year impact of switching from ranibizumab to aflibercept therapy on injection and monitoring episodes for patients undergoing intravitreal therapy for wet macular degeneration.
89 patients consecutively commenced ranibizumab therapy between May and October 2009. in a strict two stop model at a single site. The number of visits for injections and monitoring exams as well as the number of patients discharged from the programme were retrospectively analysed over a three year period up to end of October 2012. To estimate the effect of the recommended aflibercept dosing regimen, the number of patients actively managed in each twelve month period in year 1,2 and 3 were assigned to fixed dosing every two months for first year but for years 2 and 3, a two monthly follow up regimen was followed with PRN dosing on a 1;1 replacement basis for aflibercept. The numbers of injection and monitoring visits were compared between actual numbers made on the ranibizumab programme and the number on an aflibercept programme estimated from the modelling.
In the first year, 81 patients completed 12 month follow up, made 533 monitoring and 443 injection visits. 41 patients required fewer than six injections. Modelling for a two monthly fixed dosing aflibercept regimen there would have been 533 fewer monitoring visits but 41 patients would receive 86 more injections between them. 72 patients were followed to month 24 and 58 patients were followed to month 36. Over the second and third years, these patients made a total of 891 monitoring visits and received 531 injections. In the second and third year there could be a potential reduction of monitoring visits to about 445 visits by increasing follow up interval.
There is a significant natural attrition rate in numbers of patients beyond month 12. In the first twelve month a patient on aflibercept regimen would likely to experience more injections than on lucentis regimen but there should be a large reduction in monitoring visits. It should be possible to reduce the number of follow up visits in second and third year but whether the requirement for injections when using aflibercept on a PRN basis in the second and third year will be less than with ranibizumab is still uncertain.
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