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Pearse Andrew Keane, Martin McKibbin, Aaron Y Lee, Usha Chakravarthy, Robert Johnston, Catherine A Egan, Dawn A Sim, Javier Zarranz-Ventura, Adnan Tufail, AMD National EMR Study Group; United Kingdom Neovascular AMD Database study: Time to reactivation after a pause in treatment - outcomes from 92,000 intravitreal ranibizumab injections. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3066.
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To study time to reactivation in eyes that have not required treatment for 3, 6, 9 and 12 months in a very large cohort of patients and to evaluate visual outcomes in these eyes.
Participating centres collected clinical data using an electronic medical record (EMR) system, with automatic extraction of anonymized data to a database. Up to 5 years of data were collected from each centre. Centres using EMR systems that collected a minimum standard data set for eyes receiving ranibizumab therapy for nAMD including visual acuity (ETDRS), were invited to submit data, which were remotely extracted, anonymized and analyzed. Patients were treated with 3 loading injections at monthly intervals and then followed with a prn retreatment regimen.
A total of 92,976 ranibizumab treatment episodes from 12952 treated eyes associated with over 300000 clinic visits were collated from treatment naive eyes within a month of starting the study. The dataset was explored to identify eyes that had a treatment free interval of 6,9,or 12 months and Kaplan Meier graphs were generated to explore the time to reactivation after this pause. The time to reactivation for the 20th and 50th centile was 2.07/9.62 months in the 6 month, 3.69/15.84 months in the 9 month and 5.90/22.49 months in the 12 month group.
EMR has the potential to collate very large volumes of high quality data rapidly. This study provides times to reactivation that have been clinically stable for certain length of time. These outcomes will help inform rationale design of treat-and-extend regimes and guide follow up intervals patients should be reviewed at who have remained stable for a certain period.
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