Two-year outcomes of "treat and extend" intravitreal therapy for neovascular age-related macular degeneration

Jennifer J Arnold; Anna Campain; Daniel Barthelmes; Judy M Simpson; Robyn H Guymer; Alex P Hunyor; Ian L McAllister; Rohan W Essex; Nigel Morlet; Mark C Gillies; Fight Retinal Blindness Study Group

doi:10.1016/j.ophtha.2015.02.009

Two-year outcomes of "treat and extend" intravitreal therapy for neovascular age-related macular degeneration

Ophthalmology. 2015 Jun;122(6):1212-9. doi: 10.1016/j.ophtha.2015.02.009. Epub 2015 Apr 4.

Collaborators

Fight Retinal Blindness Study Group:
A Hunt¹⁰, M Gillies¹¹, A Hunt¹¹, A P Hunyor¹², J Arnold¹³, S Young¹⁴, G Clark¹⁵, Gayatri Banerjee¹⁶, R Phillips¹⁷, M Perks¹⁷, R Essex¹⁸, I McAllister¹⁹, I Constable¹⁹, R Guymer²⁰, R Guymer²¹, L Lim²¹, A Harper²¹, L P Chow²², S Wickremansinghe²³, S Wickremasinghe²⁴, S Wickremasinghe²⁵

Affiliations

¹ Marsden Eye Specialists, Parramatta, New South Wales, Australia.
² The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
³ The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. Electronic address: [email protected].
⁴ School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
⁵ Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Victoria, Australia.
⁶ The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Retina Associates, Chatswood, New South Wales, Australia.
⁷ Lions Eye Institute, Centre for Ophthalmology and Vision Science, University of Western Australia, Western Australia.
⁸ Academic Unit of Ophthalmology, Australian National University, Acton, Canberra, Australia.
⁹ University of Western Australia Department of Population Health, Perth, Western Australia.
¹⁰ Eye Surgeons Miranda, Miranda, NSW.
¹¹ Eye Associates, Sydney, NSW.
¹² Retina Associates, Chatswood, NSW.
¹³ Marsden Eye Specialists, Parramatta, NSW.
¹⁴ Gosford Eye Surgeons, Gosford, NSW.
¹⁵ Dr Clark's Practice, Lismore, NSW.
¹⁶ Nepean Valley Eye Surgeons, Penrith, NSW.
¹⁷ Eyemedics, Adelaide, SA.
¹⁸ Canberra Hospital, Garran, ACT.
¹⁹ Lions Eye Institute, Nedlands, WA.
²⁰ Centre for Eye Research Australia, East Melbourne, VIC.
²¹ Victoria Parade Eye Consultants, Fitzroy, VIC.
²² Specialists Eye Group, Glen Waverly, VIC.
²³ Doncaster Eye Centre, Doncaster, VIC.
²⁴ Caulfield Eye Clinic, Caulfield, VIC.
²⁵ Berwick Eye Centre, Berwick, VIC.

PMID: 25846847
DOI: 10.1016/j.ophtha.2015.02.009

Abstract

Purpose: To report 24-month outcomes of anti-vascular endothelial growth factor (VEGF) therapy for treatment-naïve eyes with neovascular age-related macular degeneration (nAMD) using a treat and extend treatment regimen in routine clinical practice.

Design: Database observational study.

Participants: We included treatment-naïve eyes receiving predominantly ranibizumab for nAMD in routine clinical practice treated using a treat and extend regimen that were tracked in the Fight Retinal Blindness observational registry.

Methods: A cohort of eyes treated by practitioners using exclusively a treat and extend regimen was extracted from the Fight Retinal Blindness observational registry.

Main outcome measures: Change in visual acuity (VA) over 2 years and number of injections and visits.

Results: Data from 1198 eyes from 1011 patients receiving anti-VEGF therapy using a treat and extend regimen for treatment-naïve nAMD between January 2007 and December 2012 and with 24-month follow-up were included in the analysis. Mean VA increased by +5.3 logarithm of the minimum angle of resolution letters from 56.5 letters (20/80+1) at initial visit to 61.8 (20/60+2) letters at 24 months. Mean VA gains improved and number of injections increased with successive years from +2.7 letters for eyes commencing in 2007 after a mean of 9.7 injections in 2 years, to +7.8 letters for eyes commencing in 2012 after a mean of 14.2 injections over 2 years. The proportion of eyes with VA >20/40 increased from 27% when starting treatment to 45% after 24 months; the proportion with vision of <20/200 remained unchanged (13% initial, 11% at 24 months). Of the included eyes, 90.5% avoided a vision loss of ≥15 letters. There was an overall mean of 13.0 injections over the 24 months, 7.5 injections in the first year and 5.5 in the second year, with a mean of 14.8 clinic visits.

Conclusions: These data indicate that eyes managed in routine clinical practice with a treat and extend regimen can achieve good visual outcomes while decreasing the burden of treatments and clinic visits.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Angiogenesis Inhibitors / therapeutic use*
Antibodies, Monoclonal, Humanized / therapeutic use
Bevacizumab
Female
Follow-Up Studies
Humans
Intravitreal Injections
Male
Ranibizumab
Receptors, Vascular Endothelial Growth Factor / therapeutic use
Recombinant Fusion Proteins / therapeutic use
Registries
Treatment Outcome
Vascular Endothelial Growth Factor A / antagonists & inhibitors
Visual Acuity / physiology
Wet Macular Degeneration / diagnosis
Wet Macular Degeneration / drug therapy*
Wet Macular Degeneration / physiopathology

Substances

Angiogenesis Inhibitors
Antibodies, Monoclonal, Humanized
Recombinant Fusion Proteins
VEGFA protein, human
Vascular Endothelial Growth Factor A
aflibercept
Bevacizumab
Receptors, Vascular Endothelial Growth Factor
Ranibizumab