Two-year outcomes good for “treat and extend” AMD therapy

Using a treat-and-extend regimen in routine clinical practice for patients with neovascular age-related macular degeneration (AMD) achieves good visual outcomes and decreases treatments and clinic visits, according to a study in Ophthalmology.

Researchers in Australia and Switzerland conducted a database observational study of 1198 eyes with neovascular AMD in 1011 patients, a cohort of the Fight Retinal Blindness observational registry. The treatment-naïve eyes received a treat-and-extend regimen of anti-vascular endothelial growth factor (VEGF) therapy (predominantly ranibizumab).

The 24-month outcome measures were change in visual acuity (VA) and number of anti-VEGF injections and visits.

The findings at 24 months:

• Mean VA increased from 56.5 letters (20/80+1) at initial visit to 61.8 (20/60+2) letters, a man increase of +5.3 logarithm of the minimum angle of resolution letters.

• Both the mean VA gains and the number of injections increased with successive years. Mean VA gains  increased from +2.7 letters for eyes commencing in 2007 (after a mean of 9.7 injections over 24 months), to +7.8 letters for eyes commencing in 2012 (after a mean of 14.2 injections over 24 months).

• 27% of eyes had VA >20/40 when starting treatment; that increased to 45% after 24 months.

• 13% of eyes had initial vision of <20/200; that remained unchanged (11%) at 24 months.

• 90.5% of the included avoided a vision loss of ≥15 letters.

• There was a mean of 14.8 clinic visits over 24 months. The overall mean of 13.0 injections was comprised of 7.5 injections in the first year and 5.5 in the second year.