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Param Bhatter, Abhinav Bheemidi, Justin Muste, Shirley Wu, Molly Elson, Carolina Carvalho Soares Valentim, Rishi P Singh; Treat and Extend Protocol Outcomes in Diabetic Macular Edema: A Meta-Analysis. Invest. Ophthalmol. Vis. Sci. 2022;63(7):2500 – F0226.
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Intravitreal injections of anti- vascular endothelial growth factor (anti-VEGF) agentsare considered the gold standard for treatment for diabetic macular edema (DME). Whilemonthly and as needed (PRN) injections schemes have been shown to be effective, theyconstitute a burden for patients and providers in real world clinical settings. Alternatively, treatand extend (T&E) dosing can be used titrate the anti-VEGF dosing based on an individual’sclinical response while minimizing treatment burden. This study aims to pool available data onchange in visual acuity (VA), number of injections, and change in central subfield thickness(CST) as reported by T&E regimens for DME compared to monthly and PRN regimens.
PubMed, Science Direct, and EMBASE databases were queried for studies that metthe following criteria: retrospective or prospective design, T&E regimen reported in comparisonto a monthly or PRN regimen for the treatment of DME, and a 12 month follow up period. Afterdata were extracted, analysis was performed using a random effect model. Publication bias wasexamined using a funnel plot and Egger’s linear regression test. An I^2 test was utilized todetermine heterogeneity.
Six total randomized clinical trials were identified. Three studies compared monthlyregimens to T&E. The remainder compared PRN regimens to T&E. Comparing monthly andT&E regimens, no significant difference was found between average VA improvement (p=0.30),CST improvement (p=0.28), or number of injections (p=0.20). Comparing PRN and T&Eregimens, no significant difference was found between average VA improvement (p=0.64), CSTimprovement (p=0.11), or number of injections (p=0.89).
In terms of VA and CST, T&E regiments were non-inferior to monthly or PRNregiments. No significant difference in number of injections was detected. These conclusions arelimited by study design and outcome: only six studies, which included conservative T&Eregimens were included. Furthermore, the criteria did not filter for treatment naïve patients.Future studies need to characterize the long-term reduction of treatment burden in T&Eprotocols.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
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