Abstract
Purpose :
The Treat-and Extend (T&E) method is often used by retina specialists in clinical settings in the treatment of neovascular age-related macular degeneration (nAMD). This study evaluated the outcomes of regular intravitreal ranibizumab, aflibercept, or bevacizumab in patients with nAMD in the United States over the course of six years.
Methods :
This is a retrospective, interventional, consecutive case series. 165 eyes from 137 treatment-naïve patients diagnosed with nAMD after August 2010 were treated at a single site by one physician with ranibizumab, aflibercept, or bevacizumab for ≥1 year using a T&E regimen. Patients needed to receive ≥6 injections in the first year and ≥3 injections in the following years to be included in this study. Snellen best-corrected visual acuity (BCVA) was converted to ETDRS letters using a standardized formula. The main outcome measures were: BCVA change from baseline to end of patient follow-up, mean number of injections per year, and percentage of eyes losing ≥15 letters or gaining ≥15 letters.
Results :
The average (standard deviation [SD]) baseline patient age was 78 years (8.2); 60% of patients were female. The mean follow-up period was 4.2 years, with 165, 158, 127, 108, 75, and 42 eyes completing 1, 2, 3, 4, 5, and 6 years of follow-up, respectively. The average BCVA at baseline was 53.2 letters. Mean (SD) changes from baseline in BCVA were 8.2 (21.8) letters, 7.0 (25.0) letters, 4.8 (26.9) letters, 4.6 (27.8) letters, 5.7 (27.7) letters, and 0.3 (30.1) letters for years 1, 2, 3, 4, 5, and 6, respectively. The mean number of injections received by patients in year 1 was 8. In years 2 through 6, the mean number of injections received by patients was 6. At the final follow-up, 18.8% of eyes had lost ≥15 letters and 26.1% of eyes had gained ≥15 letters.
Conclusions :
The Treat-and-Extend regimen was effective in maintaining visual acuity in patients with nAMD treated with ranibizumab, aflibercept, or bevacizumab for up to 6 years in patients who received a minimum of 6 injections in the first year and a minimum of 3 injections in the follow up years 2 through 6. The initial vision gains seen in the first 5 years of follow-up were not maintained at year 6.
This is a 2020 ARVO Annual Meeting abstract.