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Elisabet Granstam, Kersti Sjövall, Anna Paul, Laila Eriksson; Change of treatment strategy for wet AMD from PRN to Treat-and-Extend: 6 months experience from a Swedish county hospital. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5366.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the effect on treatment intensity and outcome following change of treatment strategy for wet AMD from pro re nata (PRN) to Treat-and-Extend at a Swedish county hospital using multiple monotoring activities.
Data from the national Swedish Macular Register was used to monitor number of intravitreal injections (IVI) given in clinical praxis to patients treated for wet AMD at a Swedish county hospital. Assessment of signs of disease activity on optical coherence tomography (OCT) and registration of treatment intervals was performed separately.
As of Dec 31, 2013 there were 880 eyes and 752 patients registered in the Swedish Macular Register from the county of Västmanland constituting 1.9% of the county population 70 years or older. Using the PRN treatment regimen, 139 eyes started treatment 1 May 2012 until 30 April 2013. Follow-up data at 1 year was obtained from 104 eyes. On average, each eye had 9.5 visits and received 6.9 IVI during the first treatment year. Ranibizumab was given in 95% and aflibercept in 5 % of treatments. Treatment strategy was switched to Treat-and-Extend on May 1, 2014. Four weeks later, the number of IVI administered at the department increased by 30%. Therafter, the number of IVI gradually decreased but remained at a 20% higher level compared to during PRN treatment strategy. At 6 months, the distribution of planned treatment intervals was: 4 weeks 37%, 6 weeks 28%, 8 weeks 12%, 10 weeks 5% and 12 weeks 6%. 10% of patients remained on PRN treatment. The proportion of patients without signs of acitve disease in terms of retinal and subretinal fluid on OCT was 49% compared to 30% with PRN treatment strategy.
Following change of treatment strategy for wet AMD from PRN to Treat-and-Extend the number of IVI increased, indicating that treatment according to Treat-and-Extend was more intensive for our patients. The proportion of patients without signs of retinal or subretinal fluid in the macula on OCT increased compared to during PRN-regimen, suggesting that more intensive treatment reduced AMD-related macular edema in our patient population. Addition of variables for treatment interval and presence/absence of active macular disease in the Swedish Macular Register is suggested to simplify monitoring. The effect on visual acuity will be closely followed using registry data.
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