Three-year outcomes of a treat and extend regimen of aflibercept for neovascular age-related macular degeneration

Abstract

Purpose : The treatment of neovascular age-related macular degeneration (AMD) has been revolutionized by anti-vascular endothelial growth factor (VEGF) medications. However, there is no consensus on a standard regimen of anti-VEGF medications for AMD. Recently, a treat and extend regimen (TER) has been widely used for AMD, but there has been no report of a TER for over 3 years using aflibercept. In this retrospective consecutive case series, we evaluated 3 year outcomes of intravitreal aflibercept injections using a TER for patients with AMD.

Methods : Forty-one eyes with treatment-naive AMD treated with aflibercept using a TER for 3 years were retrospectively reviewed. After three monthly loading injections, if no retinal exudative changes were seen, the interval between injections was extended by 2 weeks, up to a maximum of 16 weeks. If signs of exudation recurred, the interval was shortened by 2 weeks. The interval was shortened in increments of 4–6 weeks if the exudation recurred when the interval between injections was ≥14 weeks. The main outcome measures were changes in best corrected visual acuity (BCVA), central retinal thickness (CRT), the mean number of injections, and the interval between injections.

Results : The mean BCVA (logarithm of the minimal angle of resolution, log MAR) improved significantly from 0.36±0.31 at baseline to 0.20±0.30, 0.20±0.27, and 0.19±0.27 at year 1, 2 and 3, respectively (p<0.001 for all). At the final visit of year 3, BCVA had improved by more than 0.3 logMAR units in 15 eyes (36.6%) and was unchanged in 26 eyes (63.4%). No eyes were observed to have worsened BCVA values. Mean CRT decreased significantly from 347.8±133.4 μm at baseline to 202.8±53.6 μm, 220.0±102.7 μm, and 219.3±73.5 μm at year 1, 2 and 3, respectively (p<0.001 for all). The mean number of injections was 8.3±1.6, 6.0±2.4, and 5.8±2.5 in year 1, 2 and 3, respectively. At the final visit in year 3, the mean interval between injections was 10.5±4.0 weeks, and 34.2% of eyes were being treated at an interval of 13 weeks or more.

Conclusions : A TER of aflibercept was effective in achieving and maintaining visual and anatomic improvements in patients with AMD for up to 3 years of treatment.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.