Five-year outcomes of treat and extend regimen using intravitreal aflibercept injection for treatment-naïve age-related macular degeneration

Graefes Arch Clin Exp Ophthalmol. 2024 Nov;262(11):3483-3491. doi: 10.1007/s00417-024-06519-5. Epub 2024 May 17.

Abstract

Purpose: This study evaluated the long-term outcomes of eyes with neovascular age-related macular degeneration (nAMD) treated with aflibercept according to a treat-and-extend (T&E) regimen for up to 5 years. Methods This retrospective study included 112 eyes of 111 patients with nAMD who received aflibercept according to the T&E regimen. The patients received 3 monthly injections of aflibercept followed by a T&E regimen for at least 12 months. Data, including best-corrected visual acuity (BCVA), treatment interval, presence of exudation, central retinal thickness, and central choroidal thickness were analyzed.

Results: Of the 112 consecutive eyes, 66 completed the 5-year follow-up. After 5 years of treatment, BCVA (logMAR) was significantly better than baseline (0.29 ± 0.31 at baseline and 0.18 ± 0.23 at 5 years, P < 0.01). A mean of 7.0 ± 1.5 injections in the first year and 4.9 ± 2.2 injections per year thereafter were required. In eyes with subretinal hyperreflective material (SHRM) at baseline, BCVA at baseline and 5 years were significantly worse than in eyes without SHRM at baseline and 5 years. However, the eyes with SHRM required fewer injections and exhibited greater BCVA improvement.

Conclusion: This retrospective study demonstrated the effectiveness of the T&E regimen with aflibercept in managing nAMD over a 5-year period, maintaining significant improvements in BCVA.

Keywords: aflibercept; anti-vascular endothelial growth factor agent; neovascular age-related macular degeneration; subretinal hyperreflective material.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiogenesis Inhibitors / administration & dosage
  • Dose-Response Relationship, Drug
  • Female
  • Fluorescein Angiography*
  • Follow-Up Studies
  • Fundus Oculi
  • Humans
  • Intravitreal Injections*
  • Macula Lutea / pathology
  • Male
  • Middle Aged
  • Receptors, Vascular Endothelial Growth Factor* / administration & dosage
  • Recombinant Fusion Proteins* / administration & dosage
  • Retrospective Studies
  • Time Factors
  • Tomography, Optical Coherence*
  • Treatment Outcome
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors
  • Visual Acuity*
  • Wet Macular Degeneration* / diagnosis
  • Wet Macular Degeneration* / drug therapy
  • Wet Macular Degeneration* / physiopathology

Substances

  • Receptors, Vascular Endothelial Growth Factor
  • aflibercept
  • Recombinant Fusion Proteins
  • Angiogenesis Inhibitors
  • Vascular Endothelial Growth Factor A