Treat and Extend Treatment Interval Patterns with Anti-VEGF Therapy in nAMD Patients

Abstract

Treat and extend (T&E) is a standard treatment regimen for treating neovascular age-related macular degeneration (nAMD) with anti-vascular endothelial growth factors (anti-VEGFs), but the treatment intervals attained are not well documented. This retrospective, non-comparative, non-randomised study of eyes with nAMD classified treatment interval sequences in a T&E cohort in Australia using Electronic Medical Records (EMR) data. We analysed data from 632 treatment-naïve eyes from 555 patients injected with ranibizumab, aflibercept or unlicensed bevacizumab between January 2012 and June 2016 (mean baseline age 78.0). Eyes were categorised into non-overlapping clusters of interval sequences based on the first 12 months of follow-up. We identified 523 different treatment interval sequences. The largest cluster of 197 (31.5%) eyes attained an 8-week treatment interval before dropping to a shorter frequency, followed by 168 (26.8%) eyes that did not reach or attained a single 8-week interval at the end of the study period. A total of 65 (10.4%) and 83 (13.3%) eyes reached and sustained (≥2 consecutive injection intervals of the same length) an 8 and 12 weekly interval, respectively. This study demonstrates highly individualised treatment patterns in the first year of anti-VEGF therapy in Australia using T&E regimens, with the majority of patients requiring more frequent injections than once every 8 weeks.

Ocular Therapeutics and Molecular Delivery Strategies for Neovascular Age-Related Macular Degeneration (nAMD)

“…Though intravitreal administration of VEGF inhibitors is the first line of drugs utilized in AMD therapy, there are several limitations. Furthermore, this therapeutic modality necessitates frequent monthly or bi-monthly delivery [ 23 ] as the administered drug has a short retention time, primarily due to the high protein clearance rates from the ocular humor [ 85 ]. Intravitreal injections of VEGF inhibitors have been reported to present decreased bioavailability of the drug due to restricted ocular space, lachrymal drainage, and ocular enzymatic degradation [ 102 , 103 ].…”

“…In the present review, we highlight preclinical and clinical studies of wet AMD treatment modalities such as anti-VEGF therapy, including antibodies, bispecific antibodies, small molecules, photodynamic therapy, radiation therapy, gene therapy, and cell therapy. We are also providing information on sustained-release strategies and pharmacokinetics aspects to reduce the need for frequent injections [ 23 ].…”

Ganglion Cell Layer Thickness Change in Neovascular Age-Related Macular Degeneration Treated With Anti-VEGF Injections

“…The treat-and-extend protocol 21 included a loading phase with 3 monthly injections on initial diagnosis. Lack of detectable fluid on SD-OCT at any subsequent visit would prompt an extension of the treatment interval by 1 to 2 weeks with a maximum of 12 weeks possible.…”

Long-term efficacy and recurrence of anti-vascular endothelial growth factor therapy for idiopathic choroidal neovascularization

“…Currently, there are several treatment options for ICNV at our fingertips, intravitreal injection of antivascular endothelial growth factor (VEGF) drugs such as ranibizumab, aflibercept and off-label use of bevacizumab has previously shown to be effective in the treatment of choroidal neovascularization in age-related macular degeneration or myopic CNV (9)(10)(11). The anti-VEGF therapies has also been reported to be effective in idiopathic CNV (12).…”