Abstract
Purpose :
To compare efficacy and treatment burden of a treat-and-extend (T&E) anti-VEGF treatment of age-related macular degeneration (AMD) against fixed and pro re nata (PRN) schedules.
Methods :
MEDLINE, CENTRAL, and EMBASE were searched from 2004 to August 2020. Randomized-controlled trials and observational studies comparing T&E to PRN or fixed dosing for treatment-naïve AMD patients were included. Mean difference (MD), and 95% confidence intervals (CI) for visual acuity (VA) and injection frequency are presented. Risk of bias was assessed according to Cochrane guidelines. Methodology was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).
Results :
6 RCTs and 5 observational studies were identified. VA improvement was similar for eyes receiving T&E and fixed dosing at one (743 eyes T&E, 725 eyes fixed; MD -0.08 letters, 95% CI -2.52-2.36, p = 0.95, I2 = 69%) and two years (260 eyes T&E, 249 eyes fixed; MD 0.58 letters, 95% CI -1.74-2.90, p = 0.62, I2 = 0%). In contrast, visual acuity improvements were significantly greater for T&E eyes when compared against a PRN regimen at one (525 eyes T&E, 748 eyes PRN; MD 3.95 letters, 95% CI 2.13-5.77, p < 0.0001, I2 = 40%) and two years (85 eyes T&E, 187 eyes PRN; MD 4.08 letters, 95% CI 1.67-6.49, p < 0.001, I2 = 0%). Significantly fewer ranibizumab injections were administered in the T&E arm at one (628 eyes T&E, 604 eyes fixed; MD –2.42 injections, 95% CI -2.71 to -2.14, p < 0.0001, I2 = 0%) and two years (267 eyes T&E, 249 eyes fixed; MD –6.06 injections, 95% CI -6.79 to -5.34, p < 0.00001, I2 = 17%) relative to fixed dosing. Fewer aflibercept injections were likewise administered to patients on a T&E regimen versus fixed dosing at one year (127 eyes T&E, 124 eyes fixed; MD –0.78 injections, 95% CI -1.14 to -0.42, p < 0.0001, I2 = 53%). No studies compared T&E to fixed aflibercept at two years. Significant heterogeneity precluded meta-analysis of injection frequency among studies comparing T&E to PRN dosing.
Conclusions :
T&E preserves VA similar to fixed schedules with significantly fewer injections at one and two years. Patients on a PRN regimen receive fewer injections than those on T&E dosing, but with less favourable visual outcomes. Additional studies are required for more robust meta-analysis of anti-VEGF injection frequency at 1 year and beyond.
This is a 2021 ARVO Annual Meeting abstract.