Long-term Outcomes of Treat and Extend Regimen of Anti-vascular Endothelial Growth Factor in Neovascular Age-related Macular Degeneration

Abstract

Purpose: This study describes the long-term visual and anatomic outcomes of anti-vascular endothelial growth factor (VEGF) treatment using a treat and extend dosing regimen.

Methods: This cross-sectional cohort study consisted of 224 treatment-naïve eyes with neovascular age-related macular degeneration (NV-AMD) from 202 patients that were treated with anti-VEGF agents bevacizumab, ranibizumab, and aflibercept using a treat and extend (TAE) regimen by four physician investigators in a large urban referral center from 2008 to 2015. Subjects were evaluated for visual acuity, injection frequency, and optical coherence tomography (OCT).

Results: Over a seven-year follow-up period (mean 3.4 years), an average 20.2 $\pm$ 14.7 injections were administered with 8.4 injections in the first year and 5.5 injections by the seventh year of remaining eyes undergoing treatment. Visual acuity was 0.70 logMAR (20/100 Snellen) at the first visit and 0.67 logMAR (20/93 Snellen) at the final visit, with 74% of eyes maintaining or gaining more than 2 lines of vision. Long-term, 45.1% of eyes achieved 20/50 or better, while 27.1% were 20/200 or worse. Of the treated patients, 61.2% received monotherapy with no difference in visual acuity outcomes or number of injections between the agents used. OCT analysis showed decreased fluid from initial to final follow-up visit: 70.1-15.6% with sub-retinal fluid (SRF) and 47.3-18.8% with intra-retinal fluid (IRF) with no difference between the agents were used.

Conclusion: This study demonstrates that most patients (74%) improve or maintain visual acuity long-term using a TAE model with a significant portion (45.1%) achieving 20/50 or better visual acuity with sustained treatment.

Keywords: Intraocular Drugs; Visual Acuity; Age-related Macular Degeneration (AMD).

Figure 1

Comparison of mean visual acuity between baseline and last visit. Figure 1A shows boxplot comparisons between baseline and final visual acuities. Figure 1B shows the percentage of patients in each visual acuity category by the last follow-up visit compared to baseline.

Figure 2

Cumulative gain in logMAR over treatment course (Mean $\pm$ SE). Visual acuities recorded during patients' treatment visits were compared with the visual acuity at baseline. Only those patients actively continuing to receive injections were included in this figure; patients who discontinued injections after a specific time were not included in subsequent time points in this graph.

Figure 3

Number of injections over time. The figure shows the average annual number of injections administered over time.

Figure 4

Comparison of OCT finding between baseline and last visit. The figure shows the number of eyes with the presence of SRF and IRF pre- and post-treatment.