Individualized Therapy with Ranibizumab in Wet Age-Related Macular Degeneration

Abstract

Individualized treatment regimens may reduce patient burden with satisfactory patient outcomes in neovascular age-related macular degeneration. Intravitreal anti-VEGF drugs are the current gold standard. Fixed monthly injections offer the best visual outcome but this regimen is not commonly followed outside clinical trials. A PRN regimen requires monthly visits where the patient is treated in the presence of signs of lesion activity. Therefore, an early detection of reactivation of the disease with immediate retreatment is crucial to prevent visual acuity loss. Several trials suggest that “treat and extend” and other proactive regimens provide a reasonable approach. The rationale of the proactive regimens is to perform treatment anticipating relapses or recurrences and therefore avoid drops in vision while individualizing patient followup. Treat and extend study results in significant direct medical cost savings from fewer treatments and office visits compared to monthly treatment. Current data suggest that, for one year, PRN is less expensive, but treat and extend regimen would likely be less expensive for subsequent years. Once a patient is not a candidate to continue with treatment, he/she should be sent to an outpatient unit with adequate resources to follow nAMD patients in order to reduce the burden of specialized ophthalmologist services.

Real-world use of ranibizumab for neovascular age-related macular degeneration in Taiwan

“…In contrast, real-world settings involve a large and diverse group of patients with nAMD who may present additional manifestations of the disease at different stages (such as drusen, macular scarring, or geographic atrophy) and have confounding diseases or prior/concurrent/adjunctive treatment (such as other anti-VEGF agents, photocoagulation, or photodynamic therapy). These disease variations and individualised therapies may lead to less consistent and less satisfactory therapeutic effectiveness 26 .…”

Different Ipsi- and Contralateral Glial Responses to Anti-VEGF and Triamcinolone Intravitreal Injections in Rats

“…[15][16][17]19 Furthermore, recent investigations have documented that for a better response repeated injections are needed, at least initially, irrespective of the response to therapy. 13,[20][21][22] However, very little is known about the dosing and the possible local side effects in the retina of repeated IVI. 23 Indeed, bevacizumab and ranibizumab are humanized monoclonal antibodies and thus may trigger even in humans an inflammatory reaction, as has been shown for higher doses of these substances, 24 and the trap aflibercept may even be more inflammatory.…”

Pharmacokinetics of Intravitreal Anti-VEGF Drugs in Age-Related Macular Degeneration

“…Fixed regimens were evaluated in pivotal studies [10,11,12], in which the patients received monthly or bimonthly injections on a continuous basis over the follow up months [10,11,13]. Fixed monthly injections offer the best visual outcome, but this regimen is not commonly followed outside clinical trials due to the increased number of required visits to the ophthalmologist [14]. In addition, the followed regimen can have significant economic repercussions due to the high cost of these treatments [15].…”