Abstract
Purpose:
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.
Methods:
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.
Results:
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.
Conclusions:
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.