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Lee A, G Garg P, T Lyon A, Mirza R, K Gill M. Long-term Outcomes of Treat and Extend Regimen of Anti-vascular Endothelial Growth Factor in Neovascular Age-related Macular Degeneration. JOVR [Internet]. 2020Jul.29 [cited 2024Apr.25];15(3):331–340. Available from: https://knepublishing.com/index.php/JOVR/article/view/7452

https://doi.org/10.18502/jovr.v15i3.7452

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  • Cited by 3 articles

authors

  • Andy Lee

    Andy Lee

    Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
  • Pooja G Garg

    Pooja G Garg

    Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
  • Alice T Lyon

    Alice T Lyon

    Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
  • Rukhsana Mirza

    Rukhsana Mirza

    Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
  • Manjot K Gill

    Manjot K Gill

    Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
    https://orcid.org/0000-0002-6933-9331

Published Date

  • Jul 29, 2020
This journal is publishing all the articles under Creative Commons Attribution License CC BY 4.0.

Long-term Outcomes of Treat and Extend Regimen of Anti-vascular Endothelial Growth Factor in Neovascular Age-related Macular Degeneration

Journal of Ophthalmic and Vision Research (JOVR) / July–September 2020, Volume 15, Issue 3 / Pages 331–340

Abstract

Purpose: This study describes the long-term visual and anatomic outcomes of antivascular endothelial growth factor (VEGF) treatment using a treat and extend dosing regimen.


Methods: This cross-sectional cohort study consisted of 224 treatment-naïve eyes with neovascular age-related macular degeneration (NV-AMD) from 202 patients that were treated with anti-VEGF agents bevacizumab, ranibizumab, and aflibercept using a treat and extend (TAE) regimen by four physician investigators in a large urban referral center from 2008 to 2015. Subjects were evaluated for visual acuity, injection frequency, and optical coherence tomography (OCT).


Results: Over a seven-year follow-up period (mean 3.4 years), an average 20.2 ± 14.7 injections were administered with 8.4 injections in the first year and 5.5 injections by the seventh year of remaining eyes undergoing treatment. Visual acuity was 0.70 logMAR (20/100 Snellen) at the first visit and 0.67 logMAR (20/93 Snellen) at the final visit, with 74% of eyes maintaining or gaining more than 2 lines of vision. Long-term, 45.1% of eyes achieved 20/50 or better, while 27.1% were 20/200 or worse. Of the treated patients, 61.2% received monotherapy with no difference in visual acuity outcomes or number of injections between the agents used. OCT analysis showed decreased fluid from initial to final follow-up visit: 70.1–15.6% with sub-retinal fluid (SRF) and 47.3–18.8% with intraretinal fluid (IRF) with no difference between the agents were used.


Conclusion: This study demonstrates that most patients (74%) improve or maintain visual acuity long-term using a TAE model with a significant portion (45.1%) achieving 20/50 or better visual acuity with sustained treatment.

Keywords:

Age-related Macular Degeneration (AMD), Intraocular Drugs, Visual Acuity

References
1. Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, et al. Ranibizumab for neovascular age-related macular degeneration. New Engl J Med 2006;355:1419–1431.

2. Lalwani GA, Rosenfeld PJ, Fung AE, Dubovy SR, Michels S, Feuer W, et al. A variable-dosing regimen with intravitreal ranibizumab for neovascular age-related macular degeneration: year 2 of the PrONTO Study. Am J Ophthalmol 2009;148:43–58e1.

3. Brown DM, Michels M, Kaiser PK, Heier JS, Sy JP, Ianchulev T, et al. Ranibizumab versus verteporfin photodynamic therapy for neovascular age-related macular degeneration: two-year results of the ANCHOR study. Ophthalmology 2009;116:57–65e5.

4. Heier JS, Brown DM, Chong V, Korobelnik JF, Kaiser PK, Nguyen QD, et al. Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration. Ophthalmology 2012;119:2537–2548.

5. Schmidt-Erfurth U, Kaiser PK, Korobelnik JF, Brown DM, Chong V, Nguyen QD, et al. Intravitreal aflibercept injection for neovascular age-related macular degeneration: ninety-six-week results of the VIEW studies. Ophthalmology 2014;121:193–201.

6. Investigators IS, Chakravarthy U, Harding SP, Rogers CA, Downes SM, Lotery AJ, et al. Ranibizumab versus bevacizumab to treat neovascular age-related macular degeneration: one-year findings from the IVAN randomized trial. Ophthalmology 2012;119:1399–1411.

7. Comparison of Age-related Macular Degeneration Treatments Trials Research G, Martin DF, Maguire MG, Fine SL, Ying GS, Jaffe GJ, et al. Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results. Ophthalmology 2012;119:1388–1398.

8. Chakravarthy U, Harding SP, Rogers CA, Downes SM, Lotery AJ, Culliford LA, et al. Alternative treatments to inhibit VEGF in age-related choroidal neovascularisation: 2-year findings of the IVAN randomised controlled trial. Lancet 2013;382:1258–1267.

9. Engelbert M, Zweifel SA, Freund KB. ”Treat and extend” dosing of intravitreal antivascular endothelial growth factor therapy for type 3 neovascularization/retinal angiomatous proliferation. Retina 2009;29:1424–1431.

10. Freund KB, Korobelnik JF, Devenyi R, Framme C, Galic J, Herbert E, et al. Treat-and-extend regiments with anti- VEGF agents in retinal diseases: a literature review and consensus recommendations. Retina 2015;35:1489–1506.

11. Arnold JJ, Campain A, Barthelmes D, Simpson JM, Guymer RH, Hunyor AP, et al. Two-year outcomes of ”treat and extend” intravitreal therapy for neovascular age-related macular degeneration. Ophthalmology 2015;122:1212–1219.

12. Mrejen S, Jung JJ, Chen C, Patel SN, Gallego-Pinazo R, Yannuzzi N, et al. Long-term visual outcomes for a treat and eyes with neovascular age-related macular degeneration. J Clin Med 2015;4:1380–1402.

13. Comparison of Age-related Macular Degeneration Treatments Trials Research G, Maguire MG, Martin DF, Ying GS, Jaffe GJ, Daniel E, et al. Five-year outcomes with anti-Vascular Endothelial Growth Factor treatment of neovascular age-related macular degeneration: the comparison of age-related macular degeneration treatments trials. Ophthalmology 2016;123:1751–1761.

14. Rofagha S, Bhisitkul RB, Boyer DS, Sadda SR, Zhang K, Group S-US. Seven-year outcomes in ranibizumabtreated patients in ANCHOR, MARINA, and HORIZON: a multicenter cohort study (SEVEN-UP). Ophthalmology 2013;120:2292–2299.

15. Calvo P, Wang Y, Ferreras A, Lam WC, Denevyl R, Brent M. Treat and extend versus treat and observe in wet age-related macular degeneration patients treated with ranibizumab: 3-year surveillance period. J Clin Exp Ophthalmol 2014;5:1–5.

16. Oubraham H, Cohen SY, Samimi S, Marotte D, Bouzaher I, Bonicel P, et al. Inject and extend dosing versus dosing as needed: a comparative retrospective study of ranibizumab in exudative age-related macular degeneration. Retina 2011;1:26–30.

17. Abedi F, Wickremasinghe S, Islam AF, Inglis KM, Guymer RH. Anti-VEGF treatment in neovascular age-related macular degeneration: a treat-and-extend protocol over 2 years. Retina 2014;34:1531–1538.

18. Gupta OP, Shienbaum G, Patel AH, Fecarotta C, Kaiser RS, Regillo CD. A treat and extend regimen using ranibizumab for neovascular age-related macular degeneration clinical and economic impact. Ophthalmology 2010;117:2134– 2140.

19. Rayess N, Houston SK, 3rd, Gupta OP, Ho AC, Regillo CD. Treatment outcomes after 3 years in neovascular agerelated macular degeneration using a treat-and-extend regimen. Am J Ophthalmol 2015;159:3–8e1.

20. Shienbaum G, Gupta OP, Fecarotta C, Patel AH, Kaiser RS, Regillo CD. Bevacizumab for neovascular agerelated macular degeneration using a treat-and-extend regimen: clinical and economic impact. Am J Ophthalmol 2012;153:468–473e1.

21. DeCroos FC, Reed D, Adam MK, Salz D, Gupta OP, Ho AC, et al. Treat-and-extend therapy using aflibercept for neovascular age-related macular degeneration: a prospective clinical trial. Am J Ophthalmol 2017;180:142– 150.

22. Wykoff CC, Ou WC, Brown DM, Croft DE, Wang R, Payne JF, et al. Randomized trial of treat-and-extend versus monthly dosing for neovascular age-related macular degeneration. Ophthalmol Retina 2017;1:314–321.

23. Jaffe GJ, Martin DF, Toth CA, Daniel E, Maguire MG, Ying GS, et al. Macular morphology and visual acuity in the comparison of age-related macular degeneration treatments trials. Ophthalmology 2013;120:1860–1870.

24. Holz FG, Tuomi L, Ding B, Hopkins JJ. Development of atrophy in neovascular AMD treated with ranibizumab in the HARBOR study. Invest Ophthalmol Vis Sci 2015;56. ARVO E-Abstract 890.