Two-Year Outcomes of Treat-and-Extend Intravitreal Aflibercept for Exudative Age-Related Macular Degeneration

Maruko, Ichiro; Ogasawara, M.; Yamamoto, Akiko; Itagaki, Kanako; Hasegawa, Taiji; Arakawa, Hisaya; Nakayama, Makiko; Koizumi, Hideki; Okada, Annabelle A.; Sekiryu, Tetsuju; Iida, Tomohiro

doi:10.1016/j.oret.2020.03.010

Cited by 40 publications

(35 citation statements)

References 38 publications

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“…In a prospective study by Maruko et al 60 exploring 2-year outcomes with aflibercept T&E, vision in patients with PCV had improved by 0.13 logMAR units (approx. +6.5 ETDRS letters) at Year 2.…”

Section: Resultsmentioning

confidence: 99%

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Treat-and-Extend Regimens for the Management of Neovascular Age-related Macular Degeneration and Polypoidal Choroidal Vasculopathy: Consensus and Recommendations From the Asia-Pacific Vitreo-retina Society

Chaikitmongkol

Sagong

Lai

et al. 2021

Asia-Pacific Journal of Ophthalmology

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Purpose: Review and provide consensus recommendations on use of treat-and-extend (T&E) regimens for neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV) management with relevance for clinicians in the Asia-Pacific region. Methods: A systematic search of MEDLINE, EMBASE, and Cochrane databases, and abstract databases of the Asia-Pacific Vitreo-retina Society, European Society of Retina Specialists, American Academy of Ophthalmology, and Controversies in Ophthalmology: Asia-Australia congresses, was conducted to assess evidence for T&E regimens in nAMD. Only studies with ≥100 study eyes were included. An expert panel reviewed the results and key factors potentially influencing the use of T&E regimens in nAMD and PCV, and subsequently formed consensus recommendations for their application in the Asia-Pacific region. Results: Twenty-seven studies were included. Studies demonstrated that T&E regimens with aflibercept, ranibizumab, or bevacizumab in nAMD, and with aflibercept in PCV, were efficacious and safe. The recommendation for T&E is, after ≥3 consecutive monthly loading doses, treatment intervals can be extended by 2 to 4 weeks up to 12 to 16 weeks. When disease activity recurs, the recommendation is to reinject and shorten intervals by 2 to 4 weeks until fluid resolution, after which treatment intervals can again be extended. Intraretinal fluid should be treated until resolved; however, persistent minimal subretinal fluid after consecutive treatments may be tolerated with treatment intervals maintained or extended if the clinical condition is stable. Conclusions: T&E regimens are efficacious and safe for nAMD and PCV, can reduce the number of visits, and minimize the overall burden for clinicians and patients.

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Section: Resultsmentioning

confidence: 99%

“…These patients received fewer injections compared with an nAMD cohort over 2 years (12.0 vs 14.3, respectively; P < 0.01), with 67.3% vs 51.1% of patients with PCV and nAMD, respectively, maintained at 12-week intervals. 60 …”

Section: Resultsmentioning

confidence: 99%

Treat-and-Extend Regimens for the Management of Neovascular Age-related Macular Degeneration and Polypoidal Choroidal Vasculopathy: Consensus and Recommendations From the Asia-Pacific Vitreo-retina Society

Chaikitmongkol

Sagong

Lai

et al. 2021

Asia-Pacific Journal of Ophthalmology

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“…However, the correlation of the The choroidal thickness decreases as a result of IAI with a treat-and-extend regimen for nAMD, especially in PNV and PCV. 30 Thus far, the choroid might become thinner during recovery of the choroidal vasculature from the pathologic changes in nAMD by anti-VEGF treatment. However, we reported that the tendency for the choroid to become thin did not stop during 3 years of anti-VEGF therapy 31 .…”

Section: Discussionmentioning

confidence: 99%

Changes in complement activation products after anti-VEGF injection for choroidal neovascularization in age-related macular degeneration and pachychoroid disease

Tanaka

Oguchi

Oomori

et al. 2020

Preprint

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We evaluated changes in the complement system resulting from anti-vascular endothelial growth factor (VEGF) in eyes with age-related choroidal neovascularization (CNV) including neovascular age-related macular degeneration, pachychoroid neovasculopathy, and polypoidal choroidal neovasculopathy. We measured the concentrations of the complement activation products (C3a, C4a), VEGF, and monocyte chemotactic protein-1 in the aqueous humor during intravitreal anti-VEGF injections for CNV. The VEGF level decreased significantly (P < 0.001), while the C3a and C4a levels increased significantly (P < 0.001 for both comparisons) 1 month after two monthly anti-VEGF injections. The VEGF level was correlated with the C3a (R = 0.328, P = 0.007) and C4a (R = -0.237, P = 0.055) levels at baseline, but the correlation between the VEGF and C3a levels (R = -0.148, P = 0.242) changed significantly (P = 0.028 by analysis of covariance) after anti-VEGF treatment. The C3a increase after anti-VEGF therapy did not change the visual outcomes in eyes with CNV for 1 year. Dysregulation of the complement system can be induced by excessive reduction of intraocular VEGF after anti-VEGF therapy.

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“…In contrast, TAE uses a shortened injection interval when exudative changes remain or worsen and an extended injection interval when exudative changes disappear [14][15][16][17][18][19]. In the current study, the administration interval was extended by 2 weeks when the exudative changes disappeared after at least three monthly loading treatments, with administrations reset to the initial 1-month interval after any recurrence.…”

Section: Introductionmentioning

confidence: 85%

One-Year Results of a Treat-and-Extend Regimen of Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy

et al. 2020

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Introduction: To evaluate 1-year outcomes of intravitreal aflibercept (IVA) using a treat-andextend (TAE) regimen for polypoidal choroidal vasculopathy (PCV) and identify the factors for patients whose treatment intervals could be extended. Methods: Fifty-one eyes of treatment-naïve PCV patients treated with IVA using a TAE regimen for at least 1 year were examined retrospectively. All patients received at least three IVA injections every 5 weeks, and the intervals were then extended by 2-week adjustments up to 13 weeks. When retinal exudation recurred, the patient was treated with the same regimen, but with a shortened interval of 5 weeks.The main outcome measures were changes in bestcorrected visual acuity (BCVA) and central retinal thickness (CRT) as well as the treatment interval at 1 year. Results: The mean logarithm of the minimum angle of resolution BCVA improved from 0.24 ± 0.32 at baseline to 0.18 ± 0.31 at 12 months (p = 0.048). The mean CRT decreased from 350.3 ± 147.7 lm at baseline to 215.3 ± 75.0 lm at 4 months (p \ 0.001), after which it was maintained at this level. At 12 months, the administration interval was 5 weeks in eight eyes (15.7%), 7 weeks in six eyes (11.8%), 9 weeks in two eyes (3.9%), 11 weeks in four eyes (7.8%), and 13 weeks in 31 eyes (60.8%). Female sex, a thinner CRT at 6 months, and absence of polypoidal lesions at 12 months were significant factors related to patients whose treatment intervals could be extended without recurrence to 13 weeks. Conclusion: IVA using a TAE regimen improved visual and anatomical outcomes in eyes with PCV at 1 year using a protocol to adjust the injection intervals specifically for each patient so as to obtain no retinal exudation.

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Two-Year Outcomes of Treat-and-Extend Intravitreal Aflibercept for Exudative Age-Related Macular Degeneration

Cited by 40 publications

References 38 publications

Treat-and-Extend Regimens for the Management of Neovascular Age-related Macular Degeneration and Polypoidal Choroidal Vasculopathy: Consensus and Recommendations From the Asia-Pacific Vitreo-retina Society

Treat-and-Extend Regimens for the Management of Neovascular Age-related Macular Degeneration and Polypoidal Choroidal Vasculopathy: Consensus and Recommendations From the Asia-Pacific Vitreo-retina Society

Changes in complement activation products after anti-VEGF injection for choroidal neovascularization in age-related macular degeneration and pachychoroid disease

One-Year Results of a Treat-and-Extend Regimen of Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy

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