Impact of Disease Activity Criteria on Extending Injection Intervals in Real-World Patients with Neovascular Age-related Macular Degeneration: A Moorfields Analysis

Abstract

Purpose : In clinical practice, clinicians alter injection intervals for neovascular age-related macular degeneration (nAMD) patients based on disease activity. Treatment interval modification criteria used in clinical practice differ from those used in clinical trials potentially affecting durability outcomes.
This analysis at Moorfields Eye Hospital evaluated the potential impact of applying disease activity criteria from recent pivotal clinical trials (TENAYA/LUCERNE; HAWK/HARRIER; PULSAR) on the decision to extend the treatment interval between injections in real-world patients after the loading phase of treatment when compared to the decision taken in clinic and the impact on durability.

Methods : Clinical and imaging data were analysed from 50 consecutive, treatment naïve patients with nAMD starting faricimab treatment at Moorfields Eye Hospital. We interpreted disease activity data including visual acuity, central subfield macular thickness, presence of fluid and retinal haemorrhage from baseline to the 5^th injection.
We then applied the hypothetical disease activity criteria from TENAYA/LUCERNE, HAWK/HARRIER and PULSAR trials to determine the potential impact on the decision to extend treatment intervals at the 4^th (week 12) and 5^th (week 16) injection visits (the earliest times of disease activity assessment in our clinical practice).

Results : At the 4^th injection (week 12) visit 88% of patients had their treatment interval extended compared to 80% when applying hypothetical TENAYA/LUCERNE disease activity criteria; 84% using HAWK/HARRIER criteria and 94% using PULSAR trial criteria.
At the 5^th injection visit (week 16) 94% of patients were extended, compared to 78% applying TENAYA/LUCERNE disease activity criteria; 76% using HAWK/HARRIER and 100% using PULSAR.

Conclusions : Applying disease activity criteria from different clinical trials and comparing to clinical practice can have a significant impact on treatment intervals. Consideration should be paid to which criteria are used in real-world practice to help achieve treatment burden reductions and optimal outcomes seen in pivotal clinical trials.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.