Treat-and-extend increasingly gains favor for individualized, proactive management of neovascular AMD

by: Ocular Surgery News U.S. Edition

An appropriate treatment modality is key to the success of anti-VEGF therapy in neovascular age-related macular degeneration.

Over time, based on the results of clinical trials and their extensions, the revealing outcomes of real-life studies, and the long experience and consensus statements of many experts, the attitudes and habits of retina specialists have changed. In the United States, a treat-and-extend (T&E) regimen was favored by 66.2% of respondents to the 2015 American Society of Retina Specialists Global Trends survey, a combination of treat-and-extend and as-needed (PRN) by 18.8% and as-needed alone by 11.8%.

“Initially, people did one of two things. Some used the fixed regimens that were applied in the registration trials — MARINA and ANCHOR for Lucentis (ranibizumab, Genentech) and later VIEW1 and VIEW2 for Eylea (aflibercept, Regeneron). Others, after the PrONTO trial, were more comfortable using PRN,” K. Bailey Freund, MD, said.

Fixed regimens were mostly abandoned because patients in the real world are different from those in clinical trials. They have difficulty presenting for monthly treatment and often have more advanced disease.

“Monthly treatment may not make sense if the visual potential is very poor. Greater comfort level, long-term safety, and maintenance regimens with fewer injections and longer intervals between them seem to make more sense,” Freund said.

On the other hand, as-needed treatment still carries the burden of monthly monitoring, which does not ensure timely treatment of recurrences.

“Patients often recur within a range of 6 to 7 weeks. They may still be dry at 1 month after treatment but start to leak again a couple of weeks after the visit. With T&E, you individualize the regimen to the patient’s recurrence pattern. In this way, you treat them fewer times, more effectively and with fewer visits,” he said.

Data from a number of randomized trials, such as the TREX-AMD, TREND and CAN-TREAT studies, have shown that treat-and-extend leads to similar visual and anatomic gains as monthly treatment….

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Source: Healio