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, bevacizumab, or brolucizumab in patients with nAMD in the United States over the course of seven 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, bevacizumab, or brolucizumab 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 (8.5); 60% of patients were female. The mean follow-up period was 5 years, with 165, 158, 143, 113, 98, 64 and 32 eyes completing 1, 2, 3, 4, 5, 6, and 7 years of follow up, respectively. The average BCVA at baseline was 53 letters. Mean (SD) changes from baseline in BCVA were 8.2 (21.8) letters, 7.0 (25.0) letters, 4.4 (26.7) letters, 4.2 (27.6) letters, 4.4 (28.7) letters, 4.6 (26.2) letters, and 4.6 (37.0) letters for years 1, 2, 3, 4, 5, 6, and 7 respectively. The mean number of injections received by patients in year 1 was 8. In years 2 through 7, the mean number of injections received by patients was 6. At the final follow-up, 23.4% of male eyes and 25.7% of female eyes had lost ≥15 ETDRS letters and 28.1% of male eyes and 27.7% of female 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, bevacizumab, or brolucizumab for up to 7 years of treatment in patients who received a minimum of 6 injections in the first year and a minimum of 3 injections in follow-up years 2 through 7. To reduce overall treatment burden, the Treat-and-Extend regimen is an effective treatment option for patients.
This is a 2021 ARVO Annual Meeting abstract.