Four-year outcomes of intravitreal aflibercept treatment for neovascular age-related macular degeneration using a treat-and-extend regimen in Japanese patients

Abstract

Objective: The purpose of our study was to determine the 4-year visual and anatomic outcomes of intravitreal aflibercept treatment for neovascular age-related macular degeneration (AMD) using a treat-and-extend (TAE) regimen. Methods: We retrospectively reviewed the medical records of 39 patients with neovascular AMD who were treated continuously with intravitreal aflibercept injections using the TAE regimen for at least 4 years. The outcome measures were the best-corrected visual acuity (BCVA) and central macular thickness (CMT) on spectral-domain optical coherence tomography. The BCVAs were measured as decimal values and converted to the corresponding Early Treatment Diabetic Retinopathy Study (ETDRS) letter scores for statistical analysis. The Wilcoxon signed-rank test was used to compare the differences in BCVAs and CMTs. Results: The mean ETDRS letter scores improved significantly from 63.9 at baseline to 70.4, 67.8, 67.2, and 67.3 at 1, 2, 3, and 4 years, respectively. The mean baseline CMT was 380 µm, which decreased significantly to 229, 231, 221, and 210 µm at 1, 2, 3, and 4 years, respectively. The mean numbers of injections were 7.9, 6.0, 5.5, and 5.4 at 1, 2, 3, and 4 years, respectively. The percentages of patients with a treatment interval of 12 weeks or more were 46.2%, 46.2%, 43.6%, and 46.2% at 1, 2, 3, and 4 years, respectively. At year 4, 30.8% of the patients had a treatment interval of 7 weeks or less, whereas 25.6% had 16 weeks or more. Conclusion: Intravitreal aflibercept TAE treatment may be an effective and efficient method for treating patients with neovascular AMD up to 4 years of follow-up. The TAE regimen is a potential tool to optimize appropriate treatment intervals, avoiding both undertreatment and overtreatment of neovascular AMD.

The Influence of COVID-19 on the Stability of Patients with Neovascular Age-Related Macular Degeneration with Different Treatment Regimens

“…Compared with the monthly and PRN regimens, the T&E regimen can significantly reduce the number of follow-up visits and injections and can ease the treatment burden of patients. The T&E regimen has been proven to achieve a comparable efficacy to the traditional fixed dosing and the PRN regimens [ 14 – 16 ].…”

Current and Novel Therapeutic Approaches for Treatment of Neovascular Age-Related Macular Degeneration

“…After four years of treatment, 24% of eyes showed improvement in BCVA ≥15 letters, and 6% of eyes worsened by ≥15 letters compared with baseline. These results display that aflibercept maintains good visual outcomes in nAMD with a treat and extend TREX protocol after four years of follow-up in a real-life setting [ 77 ]. While pivotal studies have displayed noninferiority of bimonthly aflibercept to monthly ranibizumab in maintaining vision in patients with nAMD [ 78 ], this fixed dosing regimen is less sustainable than the more flexible TREX regimens and PRN regimens.…”