Injektionsstrategien bei der Anwendung intravitrealer VEGF-Inhibitoren: „Pro Re Nata versus Treat and Extend“

Abstract

The goal of this report is to provide a review on different strategies for the use of pro re nata (PRN) and treat and extend (T&E) regimens with intravitreal anti-VEGF agents (bevacizumab, ranibizumab or aflibercept) in patients with retinal diseases such as neovascular AMD, diabetic macular oedema and macular oedema due to retinal vein occlusion. The main focus is to present the effectiveness and visual outcomes of both PRN and T&E regimens in the main pivotal trials and studies based on currently available evidence. We also discuss the advantages and disadvantages of both regimens, as well as monitoring and treatment of the disease, including treatment intervals and injection frequency. Currently there is increasing interest in establishing a regimen which offers the best visual outcome with lower injection frequency, and with reduced treatment burden by individualising treatment intervals and minimising the number of clinic visits and costs. Studies have shown that the PRN regimens in a clinical setting are insufficient in assuring the best visual outcome. The PRN regime requires frequent clinic visits to monitor disease status and intravitreal treatment if needed in a reactive approach. Individualised T&E regimens can improve visual outcome and require fewer injections than those administered in a monthly regimen and fewer monitoring visits than those in a PRN regimen.

Leistungs- und Kostenkalkulation für eine universitäre, augenheilkundliche Hochschulambulanz

“…Intravitreale Injektionen (IVOMs) erfolgen im Rahmen unseres Treat-and-Extend-Regimes als eigenständiger Workflow [ 7 , 11 ]. Die Abrechnung der IVOMs erfolgt teilweise über die Hochschulambulanzpauschale und teilweise über Selektivverträge.…”

The Challenges of Treating Neovascular Age-Related Macular Degeneration

“…Disease activity is assessed using similar criteria to the PRN regimen, and the treatment interval is extended by two weeks in each case if this has decreased or stabilised, and shortened if it has increased, but never adjusted below 4 weeks or above 12(–16) weeks ( Fig. 2 ) 19 . Unlike with the PRN regimen, similar outcomes to the monthly administration regimen were achieved with the T&E protocol 17 .…”

“…Criteria include, for example, loss of over five lines of visual acuity, identification of sub- and intraretinal fluid on OCT (optical coherence tomography) or retinal bleeding ( Fig. 2 ) 17 , 19 . Despite very promising results from the first study, the results of regular 4- or 8-weekly administration could not be achieved in the subsequent studies 17 .…”

“…B. Visusabfall über 5 Buchstaben, Nachweis von sub- und intraretinaler Flüssigkeit im OCT-Scan (OCT: optische Kohärenztomografie) oder retinale Blutungen ( Abb. 2 ) 17 , 19 . Trotz vielversprechender Ergebnisse der 1.…”

Development of a Patient-Oriented Organizational Management System for Intravitreal Injection Therapy in a Standardized “Treat-and-Extend” Regime at a University Eye Clinic

“…An SD-OCT-based treat and extend (TE) system has therefore been increasingly promoted and applied in IVOM therapy, a proactive system in which patients receive an injection at each appointment, whereby extension of the injection interval is only considered if the findings are morphologically optimal or stable (SD-OCT). The advantage over PRN is clear: instead of always waiting until the findings worsen again, the next injection is timed to a point just before the next presumed deterioration of findings [24,25]. Ideally, this approach would keep the macula continuously dry.…”