Abstract
PurposeThis study describes the long-term visual and anatomic outcomes of anti-vascular endothelial growth factor (VEGF) treatment using a treat and extend dosing regimen.MethodsThis cross-sectional cohort study consisted of 224 treatment-naïve eyes with neovascular age-related macular degeneration (NV-AMD) from 202 patients that were treated with anti-VEGF agents bevacizumab, ranibizumab, and aflibercept using a treat and extend (TAE) regimen by four physician investigators in a large urban referral center from 2008 to 2015. Subjects were evaluated for visual acuity, injection frequency, and optical coherence tomography (OCT).ResultsOver a seven-year follow-up period (mean 3.4 years), an average 20.2 14.7 injections were administered with 8.4 injections in the first year and 5.5 injections by the seventh year of remaining eyes undergoing treatment. Visual acuity was 0.70 logMAR (20/100 Snellen) at the first visit and 0.67 logMAR (20/93 Snellen) at the final visit, with 74% of eyes maintaining or gaining more than 2 lines of vision. Long-term, 45.1% of eyes achieved 20/50 or better, while 27.1% were 20/200 or worse. Of the treated patients, 61.2% received monotherapy with no difference in visual acuity outcomes or number of injections between the agents used. OCT analysis showed decreased fluid from initial to final follow-up visit: 70.1–15.6% with sub-retinal fluid (SRF) and 47.3–18.8% with intra-retinal fluid (IRF) with no difference between the agents were used.ConclusionThis study demonstrates that most patients (74%) improve or maintain visual acuity long-term using a TAE model with a significant portion (45.1%) achieving 20/50 or better visual acuity with sustained treatment.
Highlights
IntroductionThe MARINA and ANCHOR studies were amongst the first to demonstrate the effects of targeting angiogenesis by blocking vascular endothelial growth factor (VEGF)-A with ranibizumab, a recombinant humanized monoclonal antibody fragment (Fab)
Treatment has evolved to control subfoveal choroidal neovascularization (CNV) growth with intravitreal drug delivery directed toward inhibition of vascular endothelial growth factor (VEGF)
We report up to a seven-year follow-up period of treatment-naïve NVAMD patients undergoing anti-VEGF therapy using a treat and extend (TAE) model
Summary
The MARINA and ANCHOR studies were amongst the first to demonstrate the effects of targeting angiogenesis by blocking VEGF-A with ranibizumab, a recombinant humanized monoclonal antibody fragment (Fab) These studies clearly showed that monthly treatment was beneficial in preventing vision loss and allowing for visual gain compared to sham and photodynamic therapy (PDT), respectively, over a two-year period.[1,2,3] The VIEW 1 and 2 trials demonstrated the efficacy of aflibercept, a soluble decoy receptor fusion protein with a higher affinity to VEGF-A and VEGF-B as well as placental growth factor (PIGF) with decreased treatment burden allowing improvement or maintenance of vision over two years.[4, 5] monthly or bimonthly injections along with monthly follow-up is challenging for patients to maintain in clinical practice
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