Anti-VEGF dosing regimen for neovascular age-related macular degeneration treatment

Abstract

antivasoproliferative therapy is a revolutionary option in the therapy of Neovascular Age-related Macular Degeneration (nAMD). In addition to the problem of choosing an anti-VEGF drug, it is equally important to choose the mode of its intravitreal administration. The basic dosing regimen is fixed monthly intravitreal injections. The effectiveness of monthly intravitreal injections has been demonstrated in randomized clinical trials; however, this regimen is associated with heavy workload on the healthcare system and patients. This fact leads to the constant search of the optimal administration mode for anti-VEGF drugs, which would reduce the number of injections by increasing the interval between them. VIEW1 and VIEW2 randomized clinical trials showed that the optimal dosing regimen for aflibercept is 1 injection every other month after 3 initial monthly doses, and that it reduces the burden of treatment. The Pro Re Nata (PRN) and Observe-and-Plan (O&P) regimens also reduce the number of injections, but the antivasoproliferative effect of the therapy with these regimens may be decreased. In addition, when using the PRN regimen, patients need regular monitoring visits and examinations between injections. The basis of another Treat and Extend (T&E) regimen is the principle of achieving the maximum possible interval between injections while preserving the achieved anatomical and functional results of the treatment. The individualized approach implemented in T&E results in pronounced functional improvements avoiding negative effect onits efficiency. However, the rapid, steady and unpredictable course of nAMD imposes certain restrictions on its implementation of T&E in clinical practice, especially in the first year of treatment. Therefore, when choosing the optimal regimen for anti-VEGF therapy, in addition to the criteria for the duration and mechanism of action of the corresponding anti-VEGF drug, the individual characteristics of the course of the disease should also be considered.