The Treat-and-Extend Injection Regimen Versus Alternate Dosing Strategies in Age-related Macular Degeneration: A Systematic Review and Meta-analysis

Okada, Mali; Kandasamy, Rathika; Chong, Elaine; McGuiness, Myra; Guymer, Robyn H.

doi:10.1016/j.ajo.2018.05.026

Cited by 60 publications

(57 citation statements)

References 25 publications

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“…This finding demonstrates that the negative perceptions of the high number of injections required in the first 12 months of treatment and lower chance of visual acuity markedly improving after 12 months of treatment, taken together, overshadowed patients' positive perceptions of the high chance for visual acuity maintenance after 2 years of treatment. In a recent meta-analysis, T&E using ranibizumab was shown to be superior to PRN and as effective as monthly dosing in improving visual acuity outcomes, 46 with a weighted frequency of 8.6 injections in 1 year. 47 The worst T&E profile, which is associated with a high number of injections required in the first 12 months of treatment, is similar to a monthly dosing regimen.…”

Section: Discussionmentioning

confidence: 99%

<p>Patient Preferences for Anti-Vascular Endothelial Growth Factor Treatment for Wet Age-Related Macular Degeneration in Japan: A Discrete Choice Experiment</p>

Joko¹,

Nagai²,

Mori³

et al. 2020

PPA

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Background: In Japan, intravitreal anti-vascular endothelial growth factor (anti-VEGF) dosing regimens for wet age-related macular degeneration (wAMD) include pro re nata, every 2 months, and treat-and-extend, resulting in different outcomes and patient burden. Although reflecting patient preferences in treatment decision-making is desirable, few studies have examined this in Japan. This study assessed the patients willingness to trade-off between different dosing regimens. Patients and Methods: Patients with wAMD were recruited from four Japanese university hospitals to complete a face-to-face cross-sectional survey. In a discrete choice experiment, patients were asked to choose their preferred option from two anti-VEGF treatment profiles shown side-by-side across a series of choice tasks. The profiles varied on four attributes: number of injections in 12 months, number of physician consultations in 12 months, chance of 1-year visual acuity (VA) improvement, and chance of 2-year VA maintenance. Preference weights were estimated using hierarchical Bayes' models. Results: Overall, 120 patients (30 treatment naïve and 90 anti-VEGF experienced) completed the survey. Patients were willing to accept an increase from three to approximately eight injections in 12 months to increase the chance of 1-year VA improvement from 25% to 40%. They would be willing to accept 11 injections in 12 months if the chance of 2-year VA maintenance increased from 80% to 96%. The most valued attributes were increasing the chance of 2-year VA maintenance and reducing the number of injections in 12 months, which were each about twice as important as decreasing physician consultations in 12 months and increasing the chance of 1-year VA improvement (p<0.001). Among the dosing regimens, patients most preferred treat-and-extend because of its higher chance of 2-year VA maintenance. Conclusion: Informing patients with wAMD about the likelihood of long-term VA maintenance when selecting treatment may increase the acceptance of an optimal treatment regimen and number of injections.

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Section: Discussionmentioning

confidence: 99%

<p>Patient Preferences for Anti-Vascular Endothelial Growth Factor Treatment for Wet Age-Related Macular Degeneration in Japan: A Discrete Choice Experiment</p>

Joko¹,

Nagai²,

Mori³

et al. 2020

PPA

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“…Real-word clinical settings differ from clinical trial in several ways: patients were unselected and diverse; with range of comorbidity and a wider range of treatments, paradigms are implemented. It has been shown that functional stability is better in T&E compared with PRN with a 1.6 more injections but fewer clinical visits [21]. Real-world studies demonstrated that proactive dosing with aflibercept yields similar outcome to those observed in clinical trials and proactive TE-regimen is superior to PRN-regimen in clinical routine care of nAMD [22][23][24].…”

Section: Discussionmentioning

confidence: 99%

Four-Year Outcome of Aflibercept Treatment-Naïve Patients for Neovascular Age-Related Macular Degeneration: Evidence from a Clinical Setting

Gayadine-Harricham

Rufin

Law-Koune

et al. 2020

Journal of Ophthalmology

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Introduction. The objective of the study is to report 4-year treatment outcome with intravitreal Aflibercept injections for neovascular age-related macular degeneration (nAMD) as first life therapy in real-life. Patients and Methods. This is a prospective, monocenter, observational case series analysis. Data from treatment-naïve patients with nAMD with at least 4 years of follow-up were included in the analysis. Data including age, gender, and visual acuity measured on Early Treatment of Diabetic Retinopathy Study charts (ETDRS) and injection numbers were recorded. Spectral domain optical coherence tomography (SD-OCT) data at baseline, month 3, month 6, month 12, year 2, 3, and 4 were also recorded. Patients were treated with a modified treat and extend (T&E) regimen. Results. Of the 48 eyes with nAMD treated, only 31 eyes were available at the 4-year follow-up. The mean age was 81 ± 8 years. The VA gain was 7.3 ± 12.7 letters at 1 year 6.5 ± 12.5 letters at 2 years, VA gain 5.2 ± 17 letters at 3 years, and 6.2 ± 18.6 letters at 4 years. The reduction of central retinal thickness was 118 ± 187 μm at 4 years. Complete resolution of fluid was obtained in 18/31 eyes. The total number of injections was 5.7 ± 2.0 during the first year, 2.9 ± 2.9 during the second year, 3.5 ± 3.3 during the third year, and 4.0 ± 3.4 during the fourth year. The total number of injections was 16 ± 10.6, ranging from 3 to 52 injections. Ten eyes developed macular atrophy over the 4-year period. Conclusion. The results suggest that good long-term morphological and functional outcome can be achieved using Aflibercept in clinical setting.

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“…Several studies like the TREX-AMD (2017), TREND (2018), and CANTREAT (2019) trials demonstrated noninferiority of ranibizumab with TER versus monthly regimen in treatment-naïve eyes, in patients treated up to 1 year [ 25 – 27 ]. Similarly, systematic reviews by Gemenetzi and Patel, Rufai et al and Okada et al suggested that TER is superior to PRN and comparable to monthly injections in the short term and highlighted the need for more real-word long-term data [ 20 , 28 , 29 ]. Of note, although we present statistically significant change in BCVA as p value <0.05 (cf.…”

Section: Discussionmentioning

confidence: 99%

“…TER consists of a loading phase of 3 monthly injections, followed by a maintenance phase where patients are given an injection at each visit and treatment interval is gradually extended or shortened, based on the absence or presence of disease activity [ 17 ]. Several trials have since demonstrated the efficacy of TER, but visual acuity outcomes remained inferior to the data obtained in the original landmark randomized clinical trials [ 18 – 20 ].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Visual Outcomes for a Treat-and-Extend Antivascular Endothelial Growth Factor Regimen in Eyes with Neovascular Age-Related Macular Degeneration: Up to Seven-Year Follow-Up

Javidi

Dirani

Antaki

et al. 2020

Journal of Ophthalmology

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Purpose. To report long-term visual and anatomical outcomes in eyes with neovascular age-related macular degeneration (nAMD) treated with a treat-and-extend regimen (TER) of intravitreal antivascular endothelial growth factor (anti-VEGF) injections in real-world settings. Methods. Retrospective cohort study of consecutive patients with nAMD treated with a TER of anti-VEGF intravitreal injections by a single retina specialist (GC). Patients with nAMD who had at least one year of follow-up were identified using an electronic database. Best-corrected visual acuity (BCVA), comprehensive ophthalmologic examination, and macular OCT were performed at each visit. Patients received a loading dose of three monthly intravitreal injections and then were treated according to a TER of bevacizumab, ranibizumab, and/or aflibercept. The number of injections, BCVA, and central retinal thickness (CRT) were evaluated during the follow-up period. Results. 180 eyes from 180 patients were included in the study. Mean age was 75 ± 9 (range: 51–96). Mean BCVA was 0.77 ± 0.64 LogMAR at baseline, 0.69 ± 0.58 LogMAR (p=0.0057) after loading phase, 0.64 ± 0.55 LogMAR (p=0.0001) after 6 months of TER, and 0.76 ± 0.71 LogMAR after 6 years of treatment (n = 32 at year 6). CRT decreased significantly after the loading phase (p=0.0002). The mean number of intravitreal injections per year was 7.6 during the first three years of treatment and then decreased to 5.9 during year 4 to 7. Conclusions. This retrospective study of 180 nAMD patients treated with a TER of intravitreal anti-VEGF demonstrates an initial improvement of BCVA after loading phase, followed by long-term visual stabilization for at least six years. These results were obtained with a high number of injections, averaging close to six injections per year during long-term follow-up. In light of the natural evolution of nAMD, these data support the long-term efficacy of this treatment under real-world conditions of heterogeneity of patients and type of anti-VEGF used.

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The Treat-and-Extend Injection Regimen Versus Alternate Dosing Strategies in Age-related Macular Degeneration: A Systematic Review and Meta-analysis

Cited by 60 publications

References 25 publications

<p>Patient Preferences for Anti-Vascular Endothelial Growth Factor Treatment for Wet Age-Related Macular Degeneration in Japan: A Discrete Choice Experiment</p>

<p>Patient Preferences for Anti-Vascular Endothelial Growth Factor Treatment for Wet Age-Related Macular Degeneration in Japan: A Discrete Choice Experiment</p>

Four-Year Outcome of Aflibercept Treatment-Naïve Patients for Neovascular Age-Related Macular Degeneration: Evidence from a Clinical Setting

Long-Term Visual Outcomes for a Treat-and-Extend Antivascular Endothelial Growth Factor Regimen in Eyes with Neovascular Age-Related Macular Degeneration: Up to Seven-Year Follow-Up

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