Recurrence of neovascular age-related macular degeneration after cessation of treat and extend regimen

Abstract

The appropriate timing of treatment cessation after treat and extend (TAE) regimen for age-related macular degeneration has not been established. This study aimed to investigate the incidence and risk factors of recurrence after cessation of the TAE regimen. We included patients who received and discontinued the TAE regimen, after extension of the treatment interval to ≥ 12 weeks. Forty-nine patients were included in the study. The estimated recurrence rates were 33% at 1 year and 48% at 2 years after treatment cessation, respectively. Good visual acuity at cessation and a large number of injections in the 6 months before cessation were significant risk factors. Higher chances of recurrence were associated with < 0.1 logarithm of the minimum angle of resolution (logMAR) at cessation (P < 0.002). Meanwhile, five patients with visual acuity ≥ 1.0 logMAR at cessation did not show recurrence. Among the 25 recurrences, two lines of vision loss were noted in only two cases after resumed treatment. This study confirmed the importance of the number of injections in reducing recurrence and the association between visual acuity and recurrence. Recurrence is generally well-controlled with resumed treatment.

Figure 1

Distribution of (a) last treatment interval, (b) total number of injections and (c) number of injections in the 6 months before cessation in patients with neovascular age-related macular degeneration who stopped treat and extend regimen of anti-vascular endothelial growth factor therapy. Recurrence was frequent in patients with last treatment interval of 12 weeks, total number of injections of less than 12 and number of injections in the 6 months before cessation of 3 or more.

Figure 2

Kaplan–Meier survival curves of recurrence after the cessation of treatment in patients with age-related macular degeneration. (a) The estimated recurrence rate was 33% at 12 months and 48% at 24 months, respectively. Patients with (b) best corrected visual acuity (BCVA) < 0.1 logMAR at cessation and (c) number of injections in the 6 months before cessation ≥ 3 had higher chance of recurrences.