Treatment Patterns and Visual Outcomes during the Maintenance Phase of Treat-and-Extend Therapy for Age-Related Macular Degeneration

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• 作者：Rohan W. Essex ; MBBS¹ ; ^{rohan.essex@act.gov.au" class="auth_mail" title="E-mail the corresponding author} ; Vuong Nguyen ; PhD² ; Richard Walton ; MSc² ; Jennifer J. Arnold ; MBBS (Hons)³ ; Ian L. McAllister ; MBBS⁴ ; Robyn H. Guymer ; MBBS ; PhD⁵ ; Nigel Morlet ; MBBS⁶ ; Stephanie Young ; MBBS⁷ ; Daniel Barthelmes ; MD ; PhD² ; ⁸ ; Mark C. Gillies ; MBBS ; PhD² ; for the Fight Retinal Blindness Study Group^&lowast ;
• 关键词：CI ; confidence interval ; CNV ; choroidal neovascularization ; FRB ; Fight Retinal Blindness ; nAMD ; neovascular age-related macular degeneration ; Q ; quartile ; SD ; standard deviation ; VA ; visual acuity
• 刊名：Ophthalmology
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：123
• 期：11
• 页码：2393-2400
• 全文大小：1196 K

文摘

To present the treatment patterns, disease activity, and visual outcomes of eyes in the maintenance phase of a treat-and-extend regimen for neovascular age-related macular degeneration (nAMD). To compare the maintenance phase behavior of eyes with a shorter induction phase (≤3 injections) with those requiring a longer induction phase (>3 injections).

Design

Database observational study.

Participants

Eyes with nAMD receiving anti-vascular endothelial growth factor (VEGF) treatment using a treat-and-extend protocol. Persistently active eyes were excluded, as were eyes with <12 months follow-up during the maintenance phase.

Methods

Clinical information from a large prospective international voluntary registry of nAMD was analyzed. The maintenance phase was defined as starting at the first clinician-reported grading of lesion inactivity.

Main Outcome Measures

For analyses by eye: treatment interval at first reactivation; time to first reactivation; and visual acuity change during the study period. For analyses by visit: choroidal neovascular membrane activity graded by the treating physician; time since previous injection; and visual acuity loss since previous injection (>0 letters and ≥15 letters).

Results

The mean change in visual acuity during the maintenance phase was +1.0 letters at 12 months &minus;0.6 letters at 24 months and &minus;1.5 at 36 months. Median treatment interval increased from 35 days at study entry to 63 days at 12 months and was 60 days at 36 months. 38.5% of eyes remained inactive at all observed visits during the maintenance phase (minimum 1 year follow-up, mean 945 days). The most common treatment interval at first reactivation was 8 weeks. Treatment intervals beyond 12 weeks seemed to be associated with increased risk of disease reactivation, with risk of reactivation reaching 37.4% at treatment intervals of ≥20 weeks. Eyes with a longer induction phase had worse visual outcomes in the maintenance phase, and earlier and more-frequent disease reactivation, although they received injections less frequently.

Conclusions

The detailed behavior of eyes in the maintenance phase of treat-and-extend management for nAMD is presented. Visual acuity was well maintained during the study period. The most common interval at which reactivation first occurred was 8 weeks. Longer duration of induction phase was associated with worse visual acuity outcomes and earlier disease reactivation, perhaps because of undertreatment.