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J. A. Patterson, N. Lee; ‘Three Strikes’ Anti-VEGF Retreatment Regime for Lucentis and Avastin in Age-Related Subretinal Neovascularisation: 3 Year Follow-Up - Effectiveness and Retreatment Injection Numbers Are Comparable to Treat and Extend Regimens. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2059.
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In current clinical practice there are several retreatment regimen paradigms in use for age-related subretinal neovascularisation (SRNVM). Detailed prospective trials (CATT, IVAN) are currently underway to answer questions about which regimen is most suitable. The optimal retreatment regime for age-related SRNVM is currently a matter for debate.Experience of the anti-VEGF regime used at Hillingdon Hospital, London, is detailed. After diangnosis and an initial 3 loading anti-VEGF injections, any reaccumulation of intraretinal fluid received 3 intravitreal anti-VEGF injections spaced one month apart. This regimen is compared with other retreatment approaches (e.g. monthly treatment, treat & extend).
403 patients who received intravitreal Lucentis (n=261) or Avastin (n=142) and completed 3 year followup at Hillingdon Hospital for age-related SRNVM from introduction of anti-VEGF treatment were included in this review. Visual outcomes using Logmar Visual acuity were measured and outcomes charted. Local and systemic adverse events were monitored.
Baseline characteristics for patients receiving Lucentis & Avastin were not significantly different. A policy of three retreatment injections produced visual improvement gains comparable to the ANCHOR & MARINA trials in the first year of treatment, with both Lucentis (+13 letters) and Avastin (+11 letters). These gains were maintained over a three year follow-up period, with a mean number of injections of 6 in the first year (5.8/y Lucentis, 5.7/y Avastin), 6/y in the second year, and 5/y in year 3 of treatment. There were no local injection-related ocular complications in either group.
A policy of three retreatment injections is a cost-effective and practical method of improving and maintaining central visual acuity in age-related SRNVM. This retreatment regimen produces equivalent efficacy in comparison to the trial gold standard of monthly injections, with fewer injections than in a monthly, or treat and extend, regimens. Efficacy was shown for both Lucentis and Avastin over the 3 year period under review. This regimen is recommended to maximise therapeutic impact of anti-VEGF therapy in age-related SRNVM, given the large numbers of patients presenting who need this sight-saving treatment.
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