Outcomes when Switching from a pro re nata Regimen to a Treat and Extend Regimen Using Aflibercept in Neovascular Age-Related Macular Degeneration

Giannakaki-Zimmermann, Helena; Ebneter, Andreas; Munk, Marion R.; Wolf, Sebastian; Zinkernagel, Martin S.

doi:10.1159/000452929

Cited by 16 publications

(18 citation statements)

References 15 publications

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“…After 2 years, 79.4% of TE patients reached injection intervals longer than eigth weeks and 47.1% of TE patients reached injection intervals longer than 10 weeks. The results of the randomized "TREND" clinical trial are in accordance to our results impressively showing that in fact chronic injection therapy can also be successful for patients on a longterm base in a real-world setting and appears to be safe as already evaluated by Giannakaki-Zimmermann et al from the Berner Group in Switzerland [12]. They could show that switching from PRN to TE in 32 patients using aflibercept resulted in stable visual gains but a significant decrease of central retinal thickness under TE.…”

Section: Resultssupporting

confidence: 88%

“…They could show that switching from PRN to TE in 32 patients using aflibercept resulted in stable visual gains but a significant decrease of central retinal thickness under TE. Herein; injection frequency increased from 7.5 (PRN) to 10.25 (TE) after 1 year for each management system [12]. Reaching a real-world setting of PRN with 7.5 injections is an extraordinary positive exception with respect to the discussed real world studies as OCEAN and AURA [6,7].…”

Section: Resultsmentioning

confidence: 95%

“…All DME and RVO patients were treatment-naïve and presented with subretinal or intraretinal macular fluid based on SD-OCT examination. With regard to Giannakaki-Zimmermann et al ( [12]) we established a strict TE management system using injection interval extensions mainly beginning from the first injection. In detail beginning with the first injection, every patient receives a macular SD-OCT using a volume scan of 49 scans, visual acuity testing and slit lamp examination of the anterior segment prior to every injection.…”

Section: Methodsmentioning

confidence: 99%

“…There is no consensual agreement about definite stop criteria. However, many specialists think that after a "dry" period of about 16 weeks a treatment stop should be considered [12].…”

Section: Introductionmentioning

confidence: 99%

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Individualized treat-and-extend regime for optimization of real-world vision outcome and improved patients’ persistence

et al. 2020

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Background: Intravitreal injections are a mandatory treatment for macular edema due to nAMD, DME and RVO. These chronic diseases usually need chronic treatment using intravitreal injections with anti-VEGF agents. Thus, many trials were performed to define the best treatment interval using pro re nata regimes (PRN), fixed regimes or treat-and-extend regimes (TE). However, real-world studies reveal a high rate of losing patients within a 2-year interval of treatment observation causing worse results. In this study we analyzed retrospectively 2 years of realworld experience with an individualized treat-and-extend injection scheme. Methods: Since 2015 our treatment scheme for intravitreal injections has been switched from PRN to TE. Out of 102 patients 59 completed a follow up time of 2 years. Every patient received visual acuity testing, SD-OCT and slit lamp examination prior to every injection. At each visit an injection was performed and the treatment interval was adjusted mainly on SD-OCT based morphologic changes by increasing or reducing in 2-week steps. Individual changes of the treatment protocol by face-to-face communication between physician and patient were possible. Results: After 1 year of treatment visual acuity gain in nAMD was 7.4 ± 2.2 ETDRS letters (n = 34; injection frequency: 7.4 ± 0.4) respectively 6.1 ± 4.7 in DME (n = 9; injection frequency: 8.4 ± 1.1) and 9.7 ± 4.5 in RVO (n = 16; injection frequency: 7.6 ± 0.5). After 2 years of treatment results were as following: nAMD: visual acuity gain 6.9 ± 2.1 (injection frequency: 12.6 ± 0.7); DME: 11.1 ± 5.1 (injection frequency: 14.0 ± 1.0); RVO: 7.5 ± 5.0 (injection frequency: 11.2 ± 0.9). Planned treatment exit after 2 year was achieved in 29.4% of patients in nAMD (0% after 1 year); 0% in DME (0% after 1 year); and 31.3% in RVO (0% after 1 year). Patients' persistence was 94.1% during the follow-up. Conclusion: Using a consequent and individualized TE regime in daily practice may lead to a high patients' persistence and visual acuity gains nearly comparable to those of large prospective clinical trials. Crucial factors are face-to-face communication with the patient as well as a stringent management regime. At this time TE may be the only instrument for proactive therapy which should therefore be regarded as a first-line tool in daily practice.

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Section: Resultssupporting

confidence: 88%

Section: Resultsmentioning

confidence: 95%

Section: Methodsmentioning

confidence: 99%

“…There is no consensual agreement about definite stop criteria. However, many specialists think that after a "dry" period of about 16 weeks a treatment stop should be considered [12].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Individualized treat-and-extend regime for optimization of real-world vision outcome and improved patients’ persistence

et al. 2020

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“…T&E has been shown to reduce injection/visit frequency compared with monthly regimens while maintaining visual acuity outcomes in patients with wAMD [ 19 ]. Outcomes were also maintained when patients with wAMD were switched from intravitreal aflibercept (IVT-AFL) PRN to T&E [ 20 , 21 ]. This paper reports the findings from the Kozawa Eye Hospital study in Japan.…”

Section: Introductionmentioning

confidence: 99%

The impact of different anti-vascular endothelial growth factor treatment regimens on reducing burden for caregivers and patients with wet age-related macular degeneration in a single-center real-world Japanese setting

Hanemoto

Hikichi

Kikuchi³

et al. 2017

PLoS ONE

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ObjectiveTo describe the burden associated with different anti-vascular endothelial growth factor (VEGF) treatment strategies for wet age-related macular degeneration (wAMD) in a real-word setting in Japan.MethodsSingle-center, cross-sectional survey of caregivers of patients with wAMD performed in a hospital in Mito-City, a rural area in Japan. Caregiver burden was evaluated using the Burden Index of Caregivers (BIC-11), and depressive symptoms were assessed by the Center for Epidemiologic Studies Depression scale. Retrospective medical chart review was conducted to monitor resource use and visual acuity outcomes in patients. The productivity loss of caregivers accompanying patients on hospital visits was estimated using the human capital method.ResultsSeventy-one patient-caregiver pairs were included. Most caregivers were female (74.6%), spouse/partner (54.9%), employed (46.5%), and the primary caregiver (85.9%). Patients received anti-VEGF treatment as follows: treat-and-extend (T&E; n = 42), switch (from as-needed [PRN] to T&E; n = 18), PRN (n = 10), and other (n = 1). Caregiver-related burden (total BIC-11 scores) were 4.29 (T&E) 4.60 (PRN), and 5.33 (switch) (p = NS).The mean number of hospital visits was lower with T&E than PRN (7.88 vs. 14.0 [p = 0.00674] in year 1 and 5.68 vs. 9.0 in year 2). For patients who switched from PRN to T&E, the mean number of hospital visits decreased from 13.21 to 7.43 (p<0.0001) in the first year after switch. The productivity loss associated with accompanying patients to the hospital was lower for caregivers of patients receiving T&E than PRN (mean differences: 74,456.04 JPY [p = 0.00284] in year 1 and 40843.14 JPY in year 2), and was also reduced for caregivers of patients who switched from PRN to T&E.ConclusionwAMD treatment with anti-VEGF agents via T&E reduced hospital visits compared with PRN, where associated monitoring visits are necessary to provide good patient outcomes. T&E was associated with a reduction trend in caregiver burden, including time and costs.

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Four-year outcome of aflibercept administration using a treat-and-extend regimen in eyes with recurrent neovascular age-related macular degeneration

et al. 2020

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Outcomes when Switching from a pro re nata Regimen to a Treat and Extend Regimen Using Aflibercept in Neovascular Age-Related Macular Degeneration

Cited by 16 publications

References 15 publications

Individualized treat-and-extend regime for optimization of real-world vision outcome and improved patients’ persistence

Individualized treat-and-extend regime for optimization of real-world vision outcome and improved patients’ persistence

The impact of different anti-vascular endothelial growth factor treatment regimens on reducing burden for caregivers and patients with wet age-related macular degeneration in a single-center real-world Japanese setting

Four-year outcome of aflibercept administration using a treat-and-extend regimen in eyes with recurrent neovascular age-related macular degeneration

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