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Saira Khanna, Rahul Komati, David Aaron Eichenbaum, Ishani Hariprasad, Thomas A Ciulla, Seenu Hariprasad; Treatment Burden and Visual Outcomes in Neovascular Age-Related Macular Degeneration (AMD). Invest. Ophthalmol. Vis. Sci. 2020;61(7):4200.
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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.
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.
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.
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.
This figure explores the relationship between the number of injections and the number of ETDRS letters gained. Even though the agents have different durability, there is a positive and clinically meaningful correlation. **Brolucizumab 3 mg dose is triangle data point above.
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