A well-known dilemma surrounding age-related macular degeneration (AMD) is that there lacks a universally accepted treatment regimen with the anti-vascular endothelial growth factor (anti-VEGF) injections.
The balance between optimal visual outcomes and treatment burden (including cost) has led some retina specialists to embrace the treat-and-extend regimen in lieu of monthly treatments. One of the more comprehensive overviews on AMD published in the last year1 reviewed evidence from both clinical trials and “real-world data” to determine how effective this particular treatment regimen is.
According to the authors, the PIER and EXCITE trials failed to achieve equal vision outcomes when anti-VEGF drugs were dosed quarterly compared to monthly dosing. SUSTAIN study was only successful with pro re nata [i.e., "as needed"] (PRN) dosing. Moving forward, a meta-analysis on CATT, HARBOR, and IVAN trials found patients on a PRN treatment had slightly significantly worse best corrected visual acuity (BCVA) and an increased risk of adverse events.
There have been prospective studies and clinical trials as well, the authors noted. For instance, Toalster et al. conducted a 12-month, open-label, nonrandomized, multicenter prospective trial using ranibizumab (Lucentis, Genentech) to access a treat-and-extend regimen using the same entry exclusion criteria as in the PrONTO trial.
Bottom line? A 9.3-letter improvement at 12 months with an average of 8 injections.