Research finds a reduction in refractory intraretinal and subretinal fluid along with improvement in visual acuity after receipt of five biweekly doses.
This article was reviewed by Eric W. Schneider, MD
Biweekly anti-VEGF dosing is a potential option for treating neovascular age-related macular degeneration (nAMD) that is refractory to chronic monthly injections, according to Eric W. Schneider, MD.
Dr. Schneider’s statement was based on a retrospective case series of 18 patients that found significant reduction in refractory intraretinal and subretinal fluid along with improvement in visual acuity after receipt of five biweekly doses. The gains achieved with biweekly dosing were reduced but not completely eliminated after patients returned to standard of care monthly dosing. No serious ocular or systemic safety events were noted during the study period.
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“Our ability to make any definitive conclusions about the safety and efficacy of biweekly dosing to treat refractory nAMD is limited by the study design. It is a small, retrospective analysis utilizing various combinations of different anti-VEGF agents and biweekly dosing regimens,” said Dr. Schneider, private practice, Tennessee Retina, Nashville, TN.
“The results are encouraging, however, and have led us to initiate a prospective study (TRISTAR) investigating biweekly aflibercept (Eylea, Regeneron) in a similarly refractory patient population,” he added. “The study is currently fully enrolled with 22 patients with the last patient’s last visit expected in November.”
Dr. Schneider noted that the study was an outgrowth of frustration with his inability to completely dry the macula in a subset of patients with nAMD. Despite aggressive monthly anti-VEGF therapy, persistent intra- and subretinal fluid remains a common challenge in treating patients with nAMD.
“We see evidence of this in our real-world clinical practices as well as in major clinical trials with all of the available anti-VEGF agents,” he said.
Dr. Schneider pointed out that there are limited options to escalate therapy in this refractory population.
“One approach is to increase the monthly dose of the anti-VEGF agent,” he explained. “This has been looked at in prospective fashion in several trials with mixed results. A second approach is to increase the frequency of dosing, an approach for which there is limited data available in the literature.”