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. 2015 Jul;29 Suppl 1(Suppl 1):S1-S11.
doi: 10.1038/eye.2015.77.

Aflibercept in wet AMD beyond the first year of treatment: recommendations by an expert roundtable panel

M McKibbin  1 , H Devonport  2 , R Gale  3 , M Gavin  4 , A Lotery  5 , S Mahmood  6 , P J Patel  7 , A Ross  8 , S Sivaprasad  7 , J Talks  9 , G Walters  10
Affiliations

Aflibercept in wet AMD beyond the first year of treatment: recommendations by an expert roundtable panel

M McKibbin et al. Eye (Lond). 2015 Jul.

Abstract

This paper provides expert recommendations on administration of aflibercept in wet age-related macular degeneration (AMD) after Year 1 (Y1), based on a roundtable discussion held in London, UK in November 2014. The goals of treatment after Y1 are to maintain visual and anatomical gains whilst minimising treatment burden and using resources effectively. The treatment decision should be made at the seventh injection visit (assuming the label has been followed) in Y1, and three approaches are proposed: (a) eyes with active disease on imaging/examination but with stable visual acuity (VA) at the end of Y1 should continue with fixed 8-weekly dosing; (b) eyes with inactive disease on imaging/examination and stable VA should be managed using a 'treat and extend' (T&E) regimen. T&E involves treating and then extending the interval until the next treatment, by 2-week intervals, to a maximum of 12 weeks, provided the disease remains inactive. If there is new evidence of disease activity, treatment is administered and the interval to the next treatment shortened; and (c) if there has been no disease activity for ≥3 consecutive visits, a trial of monitoring without treatment may be appropriate, initiated at the end of Y1 or at any time during Y2. Where possible, VA testing, OCT imaging and injection should be performed at the same visit. The second eye should be monitored to detect fellow eye involvement. In bilateral disease, the re-treatment interval should be driven by the better-seeing eye or, if the VA is similar, the eye with the more active disease.

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Conflict of interest statement

Martin McKibbin: Consulting fees from Bayer and Novartis; lecture fees from Bayer, Novartis, Alimera Sciences and Alcon; research funding from Alcon. Helen Devonport: Consulting fees from Bayer; lecture fees from Allergan, Bayer and Novartis. Richard Gale: Consulting fees from Novartis, Bayer, Alimera Sciences; lecture fees from Novartis and Bayer; research funding from Bayer and Fight for Sight. Mike Gavin: Consulting fees from Novartis, Bayer and Alimera Sciences; lecture fees from Bayer and Novartis. Andrew Lotery: Consulting fees from Novartis; lecture fees from Novartis and Bayer; educational grants from Novartis and Bayer; research funding from Novartis. Sajjad Mahmood: Consulting fees from Novartis and Bayer; lecture fees from Novartis and Bayer. Praveen J. Patel: Consulting fees from Bayer and Roche; lecture fees from Allergan; research funding from Bayer. Adam Ross: Consulting fees from Allergan and Bayer; lecture fees from Novartis. Sobha Sivaprasad: Consulting fees from Allergan, Bayer, Novartis and Roche; lecture fees from Allergan, Bayer and Novartis; and research funding from Allergan, Howard, MDS+Bayer, FFS and NIHR+Bayer. James Talks: Consulting fees from Bayer and Novartis; lecture fees from Allergan and Bayer; research funding from Novartis and Bayer. Gavin Walters: Consulting fees from Bayer; lecture fees from Bayer; research funding from Novartis, Bayer, Allergan and Alcon.

Figures

Figure 1
Figure 1
VIEW: mean change in best-corrected visual acuity (BCVA) from baseline to week 96. Reprinted from Ophthalmology, 121(1). Schmidt-Erfurth U, Kaiser PK, Korobelnik J-F, Brown DM, Chong V, Nguyen QD, et al. Intravitreal aflibercept injection for neovascular age-related macular degeneration: ninety-six-week results of the VIEW studies. p193–201 (2014), with permission from Elsevier. LS, least squares; q4, every 4 weeks; q8, every 8 weeks; R, ranibizumab.
Figure 2
Figure 2
VIEW: change to central retinal thickness from baseline to 96 weeks. Reprinted from Ophthalmology, 121(1). Schmidt-Erfurth U, Kaiser PK, Korobelnik J-F, Brown DM, Chong V, Nguyen QD, et al. Intravitreal aflibercept injection for neovascular age-related macular degeneration: ninety-six-week results of the VIEW studies. p193–201 (2014), with permission from Elsevier. q4, every 4 weeks; q8, every 8 weeks; R, ranibizumab.
Figure 3
Figure 3
Dosing schedule for aflibercept in Year 1. *Indicates when the treatment approach for post-Year 1 is determined ie at the time of the seventh injection in Year 1.
Figure 4
Figure 4
Algorithm for the treatment of wet age-related macular degeneration with aflibercept after Year 1. aIn the opinion of the treating physician. T&E, treat and extend; VA, visual acuity.
See this image and copyright information in PMC

References

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