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Klin Monbl Augenheilkd 2018; 235(08): 930-939
DOI: 10.1055/s-0042-122340
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Injektionsstrategien bei der Anwendung intravitrealer VEGF-Inhibitoren: „Pro Re Nata versus Treat and Extend“

Strategies of Intravitreal Injections with Anti-VEGF: “Pro re Nata versus Treat and Extend”
K. Hufendiek
Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover
,
A. Pielen
Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover
,
C. Framme
Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover
› Author Affiliations
Further Information

Publication History

eingereicht 11 November 2016

akzeptiert 21 November 2016

Publication Date:
23 January 2017 (online)

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Zusammenfassung

Das Ziel dieses Artikels ist es, einen Überblick zu geben über verschiedene Strategien zur Verwendung von PRN- und T&E-Therapieschemata (PRN: pro re nata; T&E: treat and extend) mit intravitrealen Anti-VEGF-Medikamenten (Bevacizumab, Ranibizumab oder Aflibercept) bei Patienten mit Netzhauterkrankungen wie neovaskulärer AMD, diabetischem Makulaödem und Makulaödem aufgrund von retinalen Venenverschlüssen. Der Schwerpunkt liegt dabei darauf, die Wirksamkeit und die Visusergebnisse des PRN- und des T&E-Regimes in Korrelation mit den wichtigsten Zulassungsstudien und Studien basierend auf den derzeit verfügbaren Daten vorzulegen. Wir diskutieren auch die Vor- und Nachteile der beiden Therapieregimes sowie die Überwachung und Behandlung der Krankheitsaktivität einschließlich der Behandlungsintervalle und Injektionsfrequenz. Derzeit gibt es ein zunehmendes Interesse, ein Regime zu etablieren, das die besten Visusergebnisse bei reduzierter Injektionsfrequenz und konsekutiv geringerer Belastung der Patienten durch individualisierte Behandlungsintervalle mit Minimierung der Anzahl der Klinikbesuche und der entstehenden Kosten bietet. Studien haben gezeigt, dass das PRN-Regime im realen Klinikalltag keine optimalen Visusergebnisse liefert. PRN erfordert häufige Arztbesuche, um den Krankheitsstatus zu kontrollieren und intravitreale Behandlung bei Bedarf reaktiv zu indizieren. Individualisierte T&E-Regimes können das Visusergebnis mit signifikant weniger Kontrolluntersuchungen verbessern im Gegensatz zu Therapieschemata mit einer monatlichen Applikation oder einem PRN-Regime.

Abstract

The goal of this report is to provide a review on different strategies for the use of pro re nata (PRN) and treat and extend (T&E) regimens with intravitreal anti-VEGF agents (bevacizumab, ranibizumab or aflibercept) in patients with retinal diseases such as neovascular AMD, diabetic macular oedema and macular oedema due to retinal vein occlusion. The main focus is to present the effectiveness and visual outcomes of both PRN and T&E regimens in the main pivotal trials and studies based on currently available evidence. We also discuss the advantages and disadvantages of both regimens, as well as monitoring and treatment of the disease, including treatment intervals and injection frequency. Currently there is increasing interest in establishing a regimen which offers the best visual outcome with lower injection frequency, and with reduced treatment burden by individualising treatment intervals and minimising the number of clinic visits and costs. Studies have shown that the PRN regimens in a clinical setting are insufficient in assuring the best visual outcome. The PRN regime requires frequent clinic visits to monitor disease status and intravitreal treatment if needed in a reactive approach. Individualised T&E regimens can improve visual outcome and require fewer injections than those administered in a monthly regimen and fewer monitoring visits than those in a PRN regimen.

Schlüsselwörter

Behandlungsregime - PRN - T&E - intravitreale Injektionen

Key words

treatment strategies - PRN - T&E - intravitreal injection
 

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