Abstract
Purpose :
Age-related macular degeneration is the leading cause of vision loss in the developed world with the expected number of affected elderly individuals reaching 17.8 million. Anti-VEGF injection therapy has been revolutionary for treatment, and numerous clinical trials have examined varying dosing regimens. When analyzing anti-VEGF agents, more injections have yielded better vision. However, this comes at the cost of a high treatment burden on patients, caregivers, and providers.
Methods :
We reviewed and analyzed studies of approved anti-VEGF agents, agents with Level 1 evidence or agents likely to undergo review by regulatory authorities. Only FDA Registration and National Eye Institute trials were included in the analysis. The anti-VEGF agents and treatment dosing regimen were analyzed for each study. We also collected the baseline ETDRS letters, mean number of injections over a 12-month period, and change in ETDRS letters over 12 months.
Results :
A total of 23 different injection regimens were analyzed for 6860 eyes. 8 (31.6%, n=2165) were ranibizumab every 4 weeks or pro re nata (PRN); 6 (28.6%, n=1962) were aflibercept dosed either every 4 or every 8 weeks; 4 (15.4%, n=1059) were abicipar every 8 weeks or 12 weeks; 3 (15.8%, n=1088) were brolucizumab dosed at every 12 or 8 weeks based on clinical activity; 2 (8.7%, n=586) were bevacizumab every 4 weeks or PRN. The mean number of injections in these studies over 12 months was 9.39 ± 2.63 and the mean change in ETDRS letters was 7.79 ± 1.43. The correlation coefficient between the number of injections and mean change in ETDRS letters is 0.61.
Conclusions :
Despite the varying durability of the different anti-VEGF agents, there is a positive correlation between the number of injections in 12-months and the change in mean BCVA (ETDRS letters). While challenging in practice, frequent treatment regimens have benefits in terms of vision, however, this needs to be mitigated by real-world constraints.
This is a 2020 ARVO Annual Meeting abstract.