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Banaee T, Alwan S, Kellogg C, Kornblau I, El-Annan J. PRN Treatment of Neovascular AMD with Cycles of Three Monthly Injections. JOVR [Internet]. 2021Apr.29 [cited 2024Apr.19];16(2):178–186. Available from: https://knepublishing.com/index.php/JOVR/article/view/9081
https://doi.org/10.18502/jovr.v16i2.9081
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authors
-
Touka Banaee
Touka Banaee
University of Texas Medical Branch in Galveston, Texas, USA
-
Shadan Alwan
Shadan Alwan
University of Texas Medical Branch in Galveston, Texas, USA
-
Clint Kellogg
Clint Kellogg
University of Texas Medical Branch in Galveston, Texas, USA
-
Ilyse Kornblau
Ilyse Kornblau
University of Texas Medical Branch in Galveston, Texas, USA
-
Jaafar El-Annan
Jaafar El-Annan
University of Texas Medical Branch in Galveston, Texas, USA
Published Date
- Apr 29, 2021
PRN Treatment of Neovascular AMD with Cycles of Three Monthly Injections
Abstract
Purpose: To report the one and two year outcome of cycles of three, monthly anti-VEGF injections given upon reactivation of the disease in eyes with neovascular age-related macular degeneration (nAMD).
Methods: Retrospective study of naïve nAMD cases with more than one year of followup, treated with a protocol of cycles of three monthly injections of anti-VEGF drugs upon reactivation. Visual acuity (VA) and central macular thickness (CMT) are the main outcome measures.
Results: Twenty-six patients with a mean age of 78.15 ± 9.29 years (57.7% female) were included. The mean follow-up was 30.89 ± 6.95 months. Treatment started with bevacizumab in all patients but in six patients was switched to aflibercept due to inadequate response to intravitreal bevacizumab injection. The mean VA at baseline and at 12 and 24 months was 53.87 ± 21.84, 60.54 ± 21.13, and 53.68 ± 27.16 ETDRS letters, respectively. Patients gained a mean of 6.67± 13.7 (p = 0.013, 95% CI= 0.60 to 12.65) and 0.77±15.21 (p = 0.4, 95% CI: –5.65 to 7.2) letters at 12 and 24 months. CMT at baseline, 12, and 24 months was 403.55 ± 147.59, 323.95 ± 79.58, and 298.59 ± 77.161 μm, respectively. The number of injections in the first and second years were 7.65 ± 2.64 and 5.52 ± 3.01, respectively. Three eyes (12.5%) lost >15 letters at 24 months.
Conclusion: This protocol can stabilize or improve vision in 87.5% of nAMD patients and can reduce the number of visits.
Keywords:
Age-related Macular Degeneration, Anti-VEGF, Naïve, Neovascular, Real World
References
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11. Mehta H, Tufail A, Daien V, Lee AY, Nguyen V, Ozturk M, et al. Real-world outcomes in patients with neovascular age-related macular degeneration treated with intravitreal vascular endothelial growth factor inhibitors. Prog Retin Eye Res 2018;65:127–146.
12. Lotery A, Griner R, Ferreira A, Milnes F, Dugel P. Realworld visual acuity outcomes between ranibizumab and aflibercept in treatment of neovascular AMD in a large US data set. Eye 2017;31:1697–1706.
13. Ciulla TA, Huang F, Westby K, Williams DF, Zaveri S, Patel SC. Real-world outcomes of anti–vascular endothelial growth factor therapy in neovascular age-related macular degeneration in the United States. Ophthalmology Retina 2018;2:645–653.
14. Rao P, Lum F, Wood K, Salman C, Burugapalli B, Hall B, et al. Real-world vision in age-related macular degeneration patients treated with single anti-VEGF drug type for 1 year in the IRIS Registry. Ophthalmology 2018;125:522–58.
15. Cohen SY, Mimoun G, Oubraham H, Zourdani A, Malbrel C, Queré S, et al. Changes in visual acuity in patients with wet age-related macular degeneration treated with intravitreal ranibizumab in daily clinical practice: the LUMIERE study. Retina 2013;33:474–481.
16. Holz FG, Tadayoni R, Beatty S, Berger A, Cereda MG, Cortez R, et al. Multi-country real-life experience of anti-vascular endothelial growth factor therapy for wet age-related macular degeneration. Br J Ophthalmol 2015;99:220–226.
17. Gillies MC, Campain A, Barthelmes D, Simpson JM, Arnold JJ, Guymer RH, et al. Long-term outcomes of treatment of neovascular age-related macular degeneration: data from an observational study. Ophthalmology 2015;122:1837–1845.
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21. 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.
22. Parvin P, Zola M, Dirani A, Ambresin A, Mantel I. Two-year outcome of an observe-and-plan regimen for neovascular age-related macular degeneration treated with Aflibercept. Graefes Arch Clin Exp Ophthalmol 2017;255:2127–2134.
23. Mantel I, Niderprim SA, Gianniou C, Deli A, Ambresin A. Reducing the clinical burden of ranibizumab treatment for neovascular age-related macular degeneration using an individually planned regimen. Br J Ophthalmol 2014;98:1192–1196.
24. Chakravarthy U, Harding SP, Rogers CA, Downes S, Lotery AJ, Dakin HA, et al. A randomised controlled trial to assess the clinical effectiveness and costeffectiveness of alternative treatments to Inhibit VEGF in Age-related choroidal Neovascularisation (IVAN). Health Technol Assess 2015;19:1–298.
25. Gupta B, Adewoyin T, Patel SK, Sivaprasad S. Comparison of two intravitreal ranibizumab treatment schedules for neovascular age-related macular degeneration. Br J Ophthalmol 2011;95:386–390.
26. Martin DF, Maguire MG, Fine SL, Ying GS, Jaffe GJ, Grunwald JE, et al. Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results. Ophthalmology 2012;119:1388–1398.
27. Rufai SR, Almuhtaseb H, Paul RM, Stuart BL, Kendrick T, Lee H, et al. A systematic review to assess the ’treat-and-extend’ dosing regimen for neovascular agerelated macular degeneration using ranibizumab. Eye 2017;31:1337–1344.
28. Chin-Yee D, Eck T, Fowler S, Hardi A, Apte RS. A systematic review of as needed versus treat and extend ranibizumab or bevacizumab treatment regimens for neovascular age-related macular degeneration. Br J Ophthalmol 2016;100:914–917.
29. Berg K, Roald AB, Navaratnam J, Bragadóttir R. An 8- year follow-up of anti-vascular endothelial growth factor treatment with a treat-and-extend modality for neovascular age-related macular degeneration. Acta Ophthalmol 2017;95:796–802.
30. Kim LN, Mehta H, Barthelmes D, Nguyen V, Gillies MC. Metaanalysis of real-world outcomes of intravitreal ranibizumab for the treatment of neovascular age-related macular degeneration. Retina 2016;36:1418–1431.
31. Johnston RL, Carius HJ, Skelly A, Ferreira A, Milnes F, Mitchell P. A retrospective study of ranibizumab treatment regimens for neovascular age-related macular degeneration (nAMD) in Australia and the United Kingdom. Adv Ther 2017;34:703–712.
32. Hatz K, Prünte C. Treat and Extend versus Pro Re Nata regimens of ranibizumab in neovascular age-related macular degeneration: a comparative 12 Month study. Acta Ophthalmol 2017;95:e67–e72.
33. Lee AY, Lee CS, Egan CA, Bailey C, Johnston RL, Natha S, et al. UK AMD/DR EMR REPORT IX: comparative effectiveness of predominantly as needed (PRN) ranibizumab versus continuous aflibercept in UK clinical practice. Br J Ophthalmol 2017;101:1683–1688.
34. Krüger Falk M, Kemp H, Sørensen TL. Four-year treatment results of neovascular age-related macular degeneration with ranibizumab and causes for discontinuation of treatment. Am J Ophthalmol 2013;155:89–95.e3.
35. Rasmussen A, Bloch SB, Fuchs J, Hansen LH, Larsen M, LaCour M, et al. A 4-year longitudinal study of 555 patients treated with ranibizumab for neovascular age-related macular degeneration. Ophthalmology 2013;120:2630–2636.
36. Gianniou C, Dirani A, Ferrini W, Marchionno L, Decugis D, Deli A, et al. Two-year outcome of an observeand- plan regimen for neovascular age-related macular degeneration: how to alleviate the clinical burden with maintained functional results. Eye 2015;29:342–349.
2. Brown DM, Kaiser PK, Michels M, Soubrane G, Heier JS, Kim RY, et al. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med 2006;355:1432–1444.
3. 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.
4. Regillo CD, Brown DM, Abraham P, Yue H, Ianchulev T, Schneider S, et al. Randomized, double-masked, shamcontrolled trial of ranibizumab for neovascular age-related macular degeneration: PIER Study year 1. Am J Ophthalmol 2008;145:239–248.
5. Schmidt-Erfurth U, Eldem B, Guymer R, Korobelnik JF, Schlingemann R, Axer-Siegel R, et al. Efficacy and safety of monthly versus quarterly ranibizumab treatment in neovascular age-related macular degeneration: the EXCITE study. Ophthalmology 2011;118:831–839.
6. Fung AE, Lalwani GA, Rosenfeld PJ, Dubovy SR, Michels S, Feuer WJ, et al. An optical coherence tomographyguided, variable dosing regimen with intravitreal ranibizumab (Lucentis) for neovascular age-related macular degeneration. Am J Ophthalmol 2007;143:566–583.
7. 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;148:43–58.e1.
8. Spaide R. Ranibizumab according to need: a treatment for age-related macular degeneration. Am J Ophthalmol 2007;143:679–680.
9. Rezaei KA, Stone TW. 2015 Global Trends in Retina Survey. Chicago, IL.: American Society of Retinal Specialists; 2015.
10. Gregori NZ, Feuer W, Rosenfeld PJ. Novel method for analyzing Snellen visual acuity measurements. Retina 2010;30:1046–1050.
11. Mehta H, Tufail A, Daien V, Lee AY, Nguyen V, Ozturk M, et al. Real-world outcomes in patients with neovascular age-related macular degeneration treated with intravitreal vascular endothelial growth factor inhibitors. Prog Retin Eye Res 2018;65:127–146.
12. Lotery A, Griner R, Ferreira A, Milnes F, Dugel P. Realworld visual acuity outcomes between ranibizumab and aflibercept in treatment of neovascular AMD in a large US data set. Eye 2017;31:1697–1706.
13. Ciulla TA, Huang F, Westby K, Williams DF, Zaveri S, Patel SC. Real-world outcomes of anti–vascular endothelial growth factor therapy in neovascular age-related macular degeneration in the United States. Ophthalmology Retina 2018;2:645–653.
14. Rao P, Lum F, Wood K, Salman C, Burugapalli B, Hall B, et al. Real-world vision in age-related macular degeneration patients treated with single anti-VEGF drug type for 1 year in the IRIS Registry. Ophthalmology 2018;125:522–58.
15. Cohen SY, Mimoun G, Oubraham H, Zourdani A, Malbrel C, Queré S, et al. Changes in visual acuity in patients with wet age-related macular degeneration treated with intravitreal ranibizumab in daily clinical practice: the LUMIERE study. Retina 2013;33:474–481.
16. Holz FG, Tadayoni R, Beatty S, Berger A, Cereda MG, Cortez R, et al. Multi-country real-life experience of anti-vascular endothelial growth factor therapy for wet age-related macular degeneration. Br J Ophthalmol 2015;99:220–226.
17. Gillies MC, Campain A, Barthelmes D, Simpson JM, Arnold JJ, Guymer RH, et al. Long-term outcomes of treatment of neovascular age-related macular degeneration: data from an observational study. Ophthalmology 2015;122:1837–1845.
18. Souied EH, Oubraham H, Mimoun G, Cohen SY, Quere S, Derveloy A, et al. Changes in visual acuity in patients with wet age-related macular degeneration treated with intravitreal ranibizumab in daily clinical practice: the TWIN study. Retina 2015;35:1743–1749.
19. Martin DF, Maguire MG, Ying GS, Grunwald JE, Fine SL, Jaffe GJ. Ranibizumab and bevacizumab for neovascular age-related macular degeneration. N Engl J Med 2011;364:1897–1908.
20. Chakravarthy U, Harding SP, Rogers CA, Downes SM, Lotery AJ, Wordsworth S, 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.
21. 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.
22. Parvin P, Zola M, Dirani A, Ambresin A, Mantel I. Two-year outcome of an observe-and-plan regimen for neovascular age-related macular degeneration treated with Aflibercept. Graefes Arch Clin Exp Ophthalmol 2017;255:2127–2134.
23. Mantel I, Niderprim SA, Gianniou C, Deli A, Ambresin A. Reducing the clinical burden of ranibizumab treatment for neovascular age-related macular degeneration using an individually planned regimen. Br J Ophthalmol 2014;98:1192–1196.
24. Chakravarthy U, Harding SP, Rogers CA, Downes S, Lotery AJ, Dakin HA, et al. A randomised controlled trial to assess the clinical effectiveness and costeffectiveness of alternative treatments to Inhibit VEGF in Age-related choroidal Neovascularisation (IVAN). Health Technol Assess 2015;19:1–298.
25. Gupta B, Adewoyin T, Patel SK, Sivaprasad S. Comparison of two intravitreal ranibizumab treatment schedules for neovascular age-related macular degeneration. Br J Ophthalmol 2011;95:386–390.
26. Martin DF, Maguire MG, Fine SL, Ying GS, Jaffe GJ, Grunwald JE, et al. Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results. Ophthalmology 2012;119:1388–1398.
27. Rufai SR, Almuhtaseb H, Paul RM, Stuart BL, Kendrick T, Lee H, et al. A systematic review to assess the ’treat-and-extend’ dosing regimen for neovascular agerelated macular degeneration using ranibizumab. Eye 2017;31:1337–1344.
28. Chin-Yee D, Eck T, Fowler S, Hardi A, Apte RS. A systematic review of as needed versus treat and extend ranibizumab or bevacizumab treatment regimens for neovascular age-related macular degeneration. Br J Ophthalmol 2016;100:914–917.
29. Berg K, Roald AB, Navaratnam J, Bragadóttir R. An 8- year follow-up of anti-vascular endothelial growth factor treatment with a treat-and-extend modality for neovascular age-related macular degeneration. Acta Ophthalmol 2017;95:796–802.
30. Kim LN, Mehta H, Barthelmes D, Nguyen V, Gillies MC. Metaanalysis of real-world outcomes of intravitreal ranibizumab for the treatment of neovascular age-related macular degeneration. Retina 2016;36:1418–1431.
31. Johnston RL, Carius HJ, Skelly A, Ferreira A, Milnes F, Mitchell P. A retrospective study of ranibizumab treatment regimens for neovascular age-related macular degeneration (nAMD) in Australia and the United Kingdom. Adv Ther 2017;34:703–712.
32. Hatz K, Prünte C. Treat and Extend versus Pro Re Nata regimens of ranibizumab in neovascular age-related macular degeneration: a comparative 12 Month study. Acta Ophthalmol 2017;95:e67–e72.
33. Lee AY, Lee CS, Egan CA, Bailey C, Johnston RL, Natha S, et al. UK AMD/DR EMR REPORT IX: comparative effectiveness of predominantly as needed (PRN) ranibizumab versus continuous aflibercept in UK clinical practice. Br J Ophthalmol 2017;101:1683–1688.
34. Krüger Falk M, Kemp H, Sørensen TL. Four-year treatment results of neovascular age-related macular degeneration with ranibizumab and causes for discontinuation of treatment. Am J Ophthalmol 2013;155:89–95.e3.
35. Rasmussen A, Bloch SB, Fuchs J, Hansen LH, Larsen M, LaCour M, et al. A 4-year longitudinal study of 555 patients treated with ranibizumab for neovascular age-related macular degeneration. Ophthalmology 2013;120:2630–2636.
36. Gianniou C, Dirani A, Ferrini W, Marchionno L, Decugis D, Deli A, et al. Two-year outcome of an observeand- plan regimen for neovascular age-related macular degeneration: how to alleviate the clinical burden with maintained functional results. Eye 2015;29:342–349.