“Treat-and-Extend” Regimen for Exudative Age-Related Macular Degeneration: A Two-Year Retrospective Follow-up Study

Abstract

Background After the introduction of a “treat-and-extend” regimen (T&E) with aflibercept for exudative age-related macular degeneration, naive eyes were compared with eyes pretreated with a “pro re nata” scheme (PRN).

Patients and Methods The Ethics Committee of Eastern Switzerland approved the retrospective single-centre study (EKOS20/084, project ID: 2020-01193). The study included 342 eyes of 303 patients newly treated with or switched to T&E between January 2018 and March 2018 at the Eye Clinic of the Cantonal Hospital St. Gallen. The gender distribution of the treated eyes was 63.5% (n = 217) female and 36.5% (n = 125) male. The mean age was 81.6 years (SD = 8.6 years). The collective was divided into three groups: 1) naive, untreated eyes (n = 92), 2) eyes with ≤ 6 previous treatments with PRN (n = 37), 3) eyes with > 6 previous treatments with PRN (n = 213). The following parameters were analysed up to December 2019: the evolution of visual acuity, the number of intravitreal injections, the number of recurrences, the duration of the follow-up, the dropout rate, and the duration of the last treatment interval.

Results During the observation period, group 1 showed a statistically significant improvement in visual acuity of + 1.5 ETDRS, while groups 2 and 3 showed a decrease in visual acuity of − 2.9 and − 3.7 ETDRS, respectively. Group 1 had better development of visual acuity than groups 2 and 3 (p = 0.005), while groups 2 and 3 were not significantly different (p = 0.92). The other parameters examined in the three groups did not differ significantly between groups.

Conclusions Treatment with aflibercept in T&E shows significantly better visual acuity in naive eyes than in eyes pretreated with PRN.

Zusammenfassung

Hintergrund Nach der Einführung eines „Treat-and-Extend“-Schemas (T&E) mit Aflibercept bei exsudativer altersbedingter Makuladegeneration wurden naive Augen mit Augen verglichen, die mit einem „Pro-re-nata“-Schema (PRN) vorbehandelt wurden.

Patienten und Methoden Die Ethikkommission der Ostschweiz hat die retrospektive monozentrische Studie bewilligt (EKOS20/084, Projekt-ID: 2020-01193). 342 Augen von 303 Patienten wurden eingeschlossen, die zwischen Januar 2018 und März 2018 in der Augenklinik des Kantonsspitals St. Gallen neu mit T&E behandelt oder darauf umgestellt wurden. Die Geschlechterverteilung der behandelten Augen war 63,5% (n = 217) weiblich und 36,5% (n = 125) männlich. Das mittlere Alter betrug 81,6 Jahre (SD = 8,6 Jahre). Die Einteilung erfolgte in 3 Gruppen: 1. naive, nicht vorbehandelte Augen (n = 92), 2. Augen mit ≤ 6 Vorbehandlungen mit PRN (n = 37), 3. Augen mit > 6 Vorbehandlungen mit PRN (n = 213). Folgende Parameter wurden bis Dezember 2019 analysiert: die Visusentwicklung, die Zahl der intravitrealen Injektionen, die Anzahl der Rezidive, die Follow-up-Dauer, die Abbrecherquote, und die Dauer des letzten Behandlungsintervalls.

Ergebnisse Im Beobachtungszeitraum zeigte sich in der Gruppe 1 eine statistisch signifikante Visusverbesserung von + 1,5 ETDRS, während es in der Gruppe 2 und 3 zu einer Visusverschlechterung von − 2,9 bzw. − 3,7 ETDRS kam. Die Gruppe 1 zeigte eine bessere Visusentwicklung als die Gruppen 2 und 3 (p = 0,005), während diese untereinander keinen signifikanten Unterschied zeigten (p = 0,92). Die anderen untersuchten Parameter wichen in den 3 Gruppen nicht signifikant voneinander ab.

Schlussfolgerungen Die Behandlung mit Aflibercept in T&E zeigt einen signifikant besseren Visusverlauf bei naiven Augen als bei mit PRN vorbehandelten Augen.

Key words

age-related macular degeneration - “treat-and-extend” regimen - anti-vascular endothelial growth factor - real-life data

Schlüsselwörter

altersbedingte Makuladegeneration - „Treat-and-Extend“-Schema - Anti-vascular endothelial Growth Factor - Real-Life-Daten

Publication History

Received: 19 September 2021

Accepted: 06 February 2022

Article published online:
26 April 2022

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