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

Abstract

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.

Evolving treatment paradigms for PCV

“…These regimens use disease activity markers of fluid in retinal compartments, visual acuity and presence of haemorrhage on clinical examination for retreatment decisions. While not as extensively studied, PCV patients undergoing a T&E protocol show favourable outcomes comparable to patients with typical nAMD [ 25 – 31 ]. However, the current disease activity indicators used for guiding subsequent retreatment decisions are based on OCT features derived from experience in typical nAMD.…”

Efficacy and Safety of Intravitreal Aflibercept Treat-and-Extend Regimens in the ALTAIR Study: 96-Week Outcomes in the Polypoidal Choroidal Vasculopathy Subgroup

“…To the best of our knowledge, the ALTAIR PCV subgroup analysis is the first prospective longer-term study (96 weeks) to explore the efficacy of IVT-AFL T&E for patients with PCV starting directly after treatment initiation in year 1. Most prior studies have not included 4-week adjustment of treatment intervals or a maximum treatment interval of 16 weeks [ 19 – 21 ], and the only reports of treatment intervals > 12 weeks are from retrospective studies [ 22 , 23 ]. Interval maintenance was also a unique feature of the ALTAIR study.…”

“…The adoption of anti-VEGF T&E regimens for the treatment of exudative AMD has been shown to maintain visual acuity while reducing treatment burden [ 15 – 18 ]. Previous studies assessing IVT-AFL T&E regimens in patients with PCV determined that it is an effective treatment option up to a maximum treatment interval of 12 weeks [ 19 – 21 ]; however, evidence for treatment intervals > 12 weeks has been limited and is only from retrospective studies [ 22 , 23 ]. Furthermore, the optimum treatment regimen for polypoidal lesion closure and reduction of subretinal hemorrhage or other exudative changes over the long term is still unknown.…”

Publication Trends of Research on Polypoidal Choroidal Vasculopathy During 2001–2020: A 20-Year Bibliometric Study

“…However, many patients still suffer from an inadequate response to anti-VEGF and require monthly injections ( 31 ). The polyp regression rate for patients who have done aflibercept monotherapy in the form of a treat-and-extend regiment for 1 year was 68.6% ( 32 ), which is to say that almost one third of patients have incomplete responses to anti-VEGF treatment. The presence of polyps always leads to rupture and exudation, which can cause the enlargement of PED as well as massive hemorrhaging ( 33 ).…”