A systematic review to assess the ‘treat-and-extend’ dosing regimen for neovascular age-related macular degeneration using ranibizumab

Rufai, Sohaib R; Almuhtaseb, Hussein; Paul, Richard H.; Stuart, Beth; Kendrick, Tony; Lee, Helena; Lotery, Andrew

doi:10.1038/eye.2017.67

Cited by 50 publications

(49 citation statements)

References 32 publications

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“…In a recent meta-analysis, T&E using ranibizumab was shown to be superior to PRN and as effective as monthly dosing in improving visual acuity outcomes, 46 with a weighted frequency of 8.6 injections in 1 year. 47 The worst T&E profile, which is associated with a high number of injections required in the first 12 months of treatment, is similar to a monthly dosing regimen. The worst T&E profile in this study was based on the available data at the time of the study, which included the Trex-AMD and LUCAS trials.…”

Section: Discussionmentioning

confidence: 99%

<p>Patient Preferences for Anti-Vascular Endothelial Growth Factor Treatment for Wet Age-Related Macular Degeneration in Japan: A Discrete Choice Experiment</p>

Joko¹,

Nagai²,

Mori³

et al. 2020

PPA

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Background: In Japan, intravitreal anti-vascular endothelial growth factor (anti-VEGF) dosing regimens for wet age-related macular degeneration (wAMD) include pro re nata, every 2 months, and treat-and-extend, resulting in different outcomes and patient burden. Although reflecting patient preferences in treatment decision-making is desirable, few studies have examined this in Japan. This study assessed the patients willingness to trade-off between different dosing regimens. Patients and Methods: Patients with wAMD were recruited from four Japanese university hospitals to complete a face-to-face cross-sectional survey. In a discrete choice experiment, patients were asked to choose their preferred option from two anti-VEGF treatment profiles shown side-by-side across a series of choice tasks. The profiles varied on four attributes: number of injections in 12 months, number of physician consultations in 12 months, chance of 1-year visual acuity (VA) improvement, and chance of 2-year VA maintenance. Preference weights were estimated using hierarchical Bayes' models. Results: Overall, 120 patients (30 treatment naïve and 90 anti-VEGF experienced) completed the survey. Patients were willing to accept an increase from three to approximately eight injections in 12 months to increase the chance of 1-year VA improvement from 25% to 40%. They would be willing to accept 11 injections in 12 months if the chance of 2-year VA maintenance increased from 80% to 96%. The most valued attributes were increasing the chance of 2-year VA maintenance and reducing the number of injections in 12 months, which were each about twice as important as decreasing physician consultations in 12 months and increasing the chance of 1-year VA improvement (p<0.001). Among the dosing regimens, patients most preferred treat-and-extend because of its higher chance of 2-year VA maintenance. Conclusion: Informing patients with wAMD about the likelihood of long-term VA maintenance when selecting treatment may increase the acceptance of an optimal treatment regimen and number of injections.

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Section: Discussionmentioning

confidence: 99%

<p>Patient Preferences for Anti-Vascular Endothelial Growth Factor Treatment for Wet Age-Related Macular Degeneration in Japan: A Discrete Choice Experiment</p>

Joko¹,

Nagai²,

Mori³

et al. 2020

PPA

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“…Both RCTs and retrospective studies using the TAE/TES method have demonstrated superior visual outcomes compared to PRN studies. In a systematic review by Rufai et al, which included the assessment of 748 eyes undergoing the TAE protocol, the one-year BCVA improvement was 8.9 letters, compared to the 3.5 letters reported by Chin-Yee et al in a separate systematic review regarding the PRN method [51]. Head to head studies, such as those by Chin-Yee et al, demonstrated an average 10.4 letter improvement in the TAE group vs. 5.4 letters in the PRN group at 12 months, with the TAE group receiving about 3.5 more injections on average [52].…”

Section: Treat-and-extend (Tae) and Treat-extend-stop (Tes) Methodsmentioning

confidence: 84%

Management Strategies and Visual Results for the Treatment of Neovascular Age-Related Macular Degeneration

Chaili¹,

Adrean²

2020

Visual Impairment and Blindness - What We Know and What We Have to Know

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The purpose of this chapter is to examine the various treatment strategies used to manage neovascular age-related macular degeneration (nAMD). The chapter will focus on the three main strategies including fixed interval dosing, as needed Pro-Re-Nata (PRN) treatment and Treat-and-Extend (TAE), with its variant the Treat-Extend-Stop (TES) protocol. We will discuss the visual results of randomized clinical trials and retrospective studies using these methodologies and compare their outcomes, the pros and cons of each treatment strategy, as well as the underlying mechanisms that may explain these differences. The results of long-term extension trials following landmark randomized clinical studies and other long-term retrospective studies will also be compared to studies using a fixed interval dosing or the TAE/ TES method. We will also focus on the visual results of the TES protocol and examine recurrence rates, proposing a definition of the recurrence of choroidal neovascularization (CNV) versus increased disease activity. These topics discussed will help optimize anti-VEGF treatment regimens for patients with nAMD over the long term.

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“…Today, we often diagnose CNV, decide whether to perform the anti-VEGF treatment and monitor the effect of treatments according to OCT scans [20], because it is safe, quick and non-invasive [12]. Morphological improvement in OCT, which shows recovery of the foveal contour, indicates a good prognosis and better recovery of retinal function [21].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of efficacy and recurrence for anti-vascular endothelial growth factor therapy in idiopathic choroidal neovascularization

Feng

Liu

et al. 2020

BMC Ophthalmol

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Background: This study aimed to evaluate the visual and morphological outcomes of intravitreal anti-VEGF therapy and the recurrence for idiopathic choroidal neovascularization (ICNV). Methods: This retrospective study included 35 patients (35 eyes) with ICNV from July 2012 to October 2017. All patients received 1 intravitreal anti-VEGF injection followed by pro re nata injections until there was no sign of ICNV activity. This was defined as the first follow-up period. To evaluate ICNV recurrence, we continued to follow-up 27 of the 35 patients for at least 2 years after the initial diagnosis, and the longest follow-up period was 5 years. Additional injection was performed when ICNV recurred. Best corrected visual acuity (BCVA) and central retinal thickness (CRT) were recorded and morphological improvement in optical coherence tomography (OCT) was assessed. Parameters that affect prognosis and recurrence were analysed.Results: The mean follow-up period was 168.0 ± 34.82 weeks. Mean BCVA improved from 56.20 ± 14.13 letters at baseline to 73.31 ± 12.57 letters (P<0.01); Mean CRT decreased from 353.6 ± 98.70 μm at baseline to 273.1 ± 53.56 μm (P < 0.001) at the end of the first follow-up period. Better baseline BCVA indicated a better morphological improvement (P = 0.026) in OCT: the lesion had completely subsided with recovery of the foveal contour. Those with high baseline BCVA (more than 60 letters) showed significant resolution of CNV lesions (P = 0.036). ICNV recurred in six patients (22.2%), 1 of whom experienced 2 recurrences. The mean timing of recurrence was 90.83 ± 49.02 weeks after diagnosis. There was no significant correlation between ICNV recurrence and the morphological improvement (P = 0.633). The final BCVA in patients with recurrence did not differ from that in patients without recurrence (P = 0.065).

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A systematic review to assess the ‘treat-and-extend’ dosing regimen for neovascular age-related macular degeneration using ranibizumab

Cited by 50 publications

References 32 publications

<p>Patient Preferences for Anti-Vascular Endothelial Growth Factor Treatment for Wet Age-Related Macular Degeneration in Japan: A Discrete Choice Experiment</p>

<p>Patient Preferences for Anti-Vascular Endothelial Growth Factor Treatment for Wet Age-Related Macular Degeneration in Japan: A Discrete Choice Experiment</p>

Management Strategies and Visual Results for the Treatment of Neovascular Age-Related Macular Degeneration

Evaluation of efficacy and recurrence for anti-vascular endothelial growth factor therapy in idiopathic choroidal neovascularization

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