Amid a treatment burden of regular injections, retina specialists have oved to treat-and-extend regimens, the effectiveness of which is supported by the literature.
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Wet AMD study
In collaboration with Novartis and Verana Health, my colleagues and I recently evaluated real-world injection intervals in treatment-naïve patients with wet AMD.3
The analysis included records for eyes with a diagnosis of wet AMD, at least one anti-VEGF injection during the study period (July 1, 2013 to Nov. 2, 2017) and no anti-VEGF treatments during the six months (baseline period) preceding the first injection date (index date).
Additionally, all eyes had to have had at least hand-motion vision during the baseline period and no record of other conditions that can be treated with anti-VEGF agents (e.g., diabetic macular edema or retinal vein occlusion).
The survey also ensured it excluded patients who may have impacted the findings.
Out of more than 1.7 million patients who received anti-VEGF injections during the study period, many thousands were excluded because they were already being treated with anti-VEGF therapy, or because they had diagnoses other than wet AMD. In all, records for 56,672 eyes of 54,392 patients met the criteria for analysis.
The mean age of the patients was 81.1 ±8.4 years and nearly 65% were female. Visual acuity at baseline was distributed around 20/80, as we have seen in other studies. About one-quarter of the eyes had worse than 20/200 acuity at baseline, which highlights the need for earlier diagnosis and initiation of treatment.
Injection intervals were determined for all eyes and compared with those treated with the branded anti-VEGF therapies available during the study period: aflibercept (Eylea, Regeneron, n = 13,467 eyes) and ranibizumab (Lucentis, Genentech, n = 9,128 eyes).
The mean number of injections per eye was about five per year. There was little apparent difference between Year 1 and Year 2 of treatment, among patients that received treatment within a given year, or between the two branded anti-VEGF agents studied.
All in all, this is fewer injections annually than we might have expected.
When we looked only at eyes that were treated with one drug at the beginning and end of a full year (or two years), we found wide variation in injection intervals.
We would expect the injection interval to be short during the initial months of treatment, and longer after the physician uses a treat-and-extend treatment approach.
1. Rufai SR, Almuhtaseb H, Paul RM, et al. A systematic review to assess the ‘treat-and-extend’ dosing regimen for neovascular age-related macular degeneration using ranibizumab. Eye. 2017;31:1337-1344.
2. Vardarinos A, Gupta N, Janjua R, et al. 24-month clinical outcomes of a treat-and-extend regimen with ranibizumab for wet age-related macular degeneration in a real-life setting. BMC Ophthalmol. 2017;17:58.
3. MacCumber M, Yu, JS, Sagkriotis A, et al. Injection intervals in treatment-naïve neovascular AMD patients who received anti-VEGF agents: An analysis of the IRIS Registry. American Academy of Ophthalmology, San Francisco, 2019:PO471.