Abstract
Purpose :
To evaluate visual and anatomical outcomes of treat and extend (TREX) protocol in patients with wet type of age-related macular degeneration (AMD), receiving treatment with ranibizumab.
Methods :
Retrospective, non-randomized study of patients with wet AMD, who were treated with ranibizumab either by switching from pro re nata (PRN) to a TREX regimen or by starting treatment according to TREX protocol. LogMAR (ETDRS) best corrected visual acuity (BCVA), central retinal thickness (CRT), number of injections, duration of treatment, number of visits and maximum treatment interval accomplished were recorded.
Results :
51 eyes (51 patients) were included; 30 patients switched to TREX from a PRN regimen, from which 15 (out of 30) patients were used for direct comparison between the two regimens; 21 treatment naive patients started treatment following TREX protocol. After switching to TREX regimen, mean number of injections was 5,1 +1,5 in a mean follow-up period of 8,7 +3,8 months (3,5 injection/ 6months). Switching from PRN to TREX resulted in a mean loss of 2,8 +6,7 letters on ETDRS [p: 0,22] and a mean reduction of 15,5 +38,3 μm [p: 0,12] in CRT. Regarding the direct regimen comparison group, after omitting PRN initial loading treatment phase and comparing the two regimens for equal durations (about 11 months), only the number of visits (PRN: 7,3 +1,9 vs TREX: 6 +1,2; p: 0,01) was significantly different between the 2 groups. Regarding patients starting treatment with TREX protocol, during 12,7 +4,2 months, 7,5 +1,8 injections were received. Patients gained 6,2 +8,5 letters [p: < 0,01], while mean CRT was reduced by 105,6 +153,8 μm [p: < 0,01]. In addition, 15 (out of 21) patients from the treatment naïve group (TREXn group), were retrospectively compared with 15 treatment naïve PRN patients (PRNn group). For a median treatment period of 15 months, non-significant differences were recorded in BCVA, CRT and number of injections between groups. Significantly less patient visits were recorded in the TREXn group compared to the PRNn group (TREXn: 8,6 +1,8 vs PRNn: 11 +2,5; p: 0,01).
Conclusions :
Switching wet AMD patients from PRN to TREX regimen seems to provide equal anatomical and functional results with less patient visits. TREX protocol provides excellent outcomes in treatment naïve patients combined with a more predictable injection workload with fewer patient visits when compared to PRN regimen.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.