One-Year Outcomes of the Treat-and-Extend Approach with Aflibercept in Age-Related Macular Degeneration: Effects on Typical Choroidal Neovascularization and Retinal Angiomatous Proliferation

Abstract

Objective: To investigate functional/morphological outcomes of the treat-and-extend regimen (TER) with aflibercept in typical choroidal neovascularization (CNV) and retinal angiomatous proliferation (RAP) secondary to exudative age-related macular degeneration (AMD). Methods: This was a retrospective study of 37 eyes treated with 2 mg aflibercept according to a TER protocol. Examinations included best corrected visual acuity (BCVA), numbers of injections, and visits needed. Additionally, quantitative/qualitative analyses with fluorescein angiography and spectral- domain optical coherence tomography were conducted at baseline as well as at 3, 6, and 12 months. Results: BCVA significantly improved from 0.6 ± 0.27 to 0.4 ± 0.34 logMAR. The final mean numbers of injections were 8.03 ± 1.27 and 7.28 ± 0.75 and the numbers of visits 6.5 ± 1.09 and 7.14 ± 1.57 in typical CNV and in RAP or atypical CNV, respectively, and they did not differ between the different subtypes of CNV (p > 0.05). Conclusions: Aflibercept in TER is effective for all exudative AMD subtypes. The patient's visual gain, the mean number of injections, and the number of visits needed did not depend on the subtype of CNV.

Creation of a neovascular age‐related macular degeneration national database using a web‐based platform: Fight Retinal Blindness Spain. Report 1: Visual outcomes

“…Organisational problems, confusion over scheduling and healthcare resource availability were also identified as potential roadblocks for implementing proactive treatment regimens in real‐world scenarios. Measures directed to solve administrative and managerial issues can be effectively implemented in single centres, as described in recent reports with adequate results, the challenge is to scale these measures nationwide in a multicentre setting 22–25 . This may be one of the reasons why real world multicentric studies underperform compared to clinical trials even with fixed regimens (i.e., +5.1 vs. +8.4 letters at 12 months in the UK aflibercept cohort) 7 .…”

“…In Spain, data about AMD real world outcomes are scarce. There is only one previous multicentric report in the PRN era in 2013, which clearly reported undertreatment in a small series of 12 selected centres, 21 and few small single centre series that presented data with FB and TAE regimens 22–25 . For these reasons, no information is available about the visual outcomes and treatment frequency achieved with proactive regimens nationwide in Spain, as no multicentric studies have been previously conducted in routine clinical care.…”

Two-Year Outcomes of a Treat-and-Extend Regimen Using Intravitreal Aflibercept Injections for Typical Age-Related Macular Degeneration

“…Castro-Navarro et al [15] reported the 1-year outcomes of a TAE regimen using aflibercept for 37 eyes with treatment-naïve AMD (29 eyes with tAMD [type 1 CNV: 41.3%, type 2 CNV: 37.9%, mixed CNV: 20.6%] and 8 eyes with retinal angiomatous proliferation). They reported a mean number of injections in 1 year of 7.89 (8.03 in the tAMD group and 7.28 in the retinal angiomatous proliferation group) and a significantly improved average BCVA.…”

“…However, reports on the therapeutic outcomes of TAE with aflibercept for treatment-naïve exudative AMD are rare [15] . Here, we report the 2-year outcomes of a TAE regimen using aflibercept for tAMD.…”

Burden of disease assessment in patients with neovascular age-related macular degeneration in Spain: Results of the AMD-MANAGE study

“…Sample size estimation was based on previous nAMD studies on treatment use under real conditions in Spain. 11–18…”