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Review
. 2025 Apr;39(5):860-869.
doi: 10.1038/s41433-024-03370-0. Epub 2024 Oct 8.

Treatment regimens for optimising outcomes in patients with neovascular age-related macular degeneration

Kelvin Yi Chong Teo  1 , Bora Eldem  2 , Antonia Joussen  3 , Adrian Koh  4 , Jean-François Korobelnik  5   6 , Xiaoxin Li  7 , Anat Loewenstein  8 , Monica Lövestam-Adrian  9 , Rafael Navarro  10 , Annabelle A Okada  11 , Ian Pearce  12 , Francisco Rodríguez  13 , David Wong  14 , Lihteh Wu  15 , Dinah Zur  8 , Javier Zarranz-Ventura  16 , Paul Mitchell  17 , Varun Chaudhary  18   19 , Paolo Lanzetta  20
Affiliations
Review

Treatment regimens for optimising outcomes in patients with neovascular age-related macular degeneration

Kelvin Yi Chong Teo et al. Eye (Lond). 2025 Apr.

Abstract
in English, Chinese

Practice patterns for neovascular age-related macular degeneration (nAMD) have evolved from the landmark registration trials of vascular endothelial growth factor (VEGF) inhibitors. Non-monthly regimens like treat-and-extend (T&E) have become popular due to their effectiveness in clinical practice. T&E regimens attempt to limit the burden of visits and treatments by allowing progressively longer treatment intervals, but in so doing, are potentially associated with the expense of treating quiescent disease. This is acceptable to many patients and their ophthalmologists but can still be problematic in the real-world. Recent studies have further refined the T&E approach by allowing for quicker and longer extension of treatment intervals when less severe disease is detected. With newer drugs offering increased durability, a shift to longer regular intervals may emerge as a new practice pattern for VEGF inhibitor therapy. This review aims to consolidate the current literature on the most effective treatment patterns and update treatment guidelines based on options that are now available. It also summarises new aspects of nAMD management that may help to further refine current practice.

摘要: 新生血管性年龄相关性黄斑变性(nAMD)的治疗模式已从具有里程碑意义的血管内皮生长因子 (VEGF) 抑制剂注册试验中进行转变。治疗并延长方案(T&E)等非每月治疗方案因其在临床实践中的有效性而被广泛应用。T&E方案旨在通过逐渐延长治疗间隔来减轻就诊和治疗的负担, 但可能增加静止期疾病的治疗费用。这对许多患者及眼科医生来说可以接受, 但在真实世界中实施仍存在困难。最近的研究进一步完善了T&E方案, 当检测到病情较轻时, 可以更快、更长地延长治疗间隔。随着新药物提供了更高的持久性, 转向更长的规律间隔将成为VEGF抑制剂治疗的新的临床模式。本文旨在综合目前关于有效治疗模式的文献, 并根据现有的有效方案更新治疗指南。本文还总结了nAMD管理的新的进展, 有助于进一步完善当前的临床实践。.

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Conflict of interest statement

Competing interests: KYCT: Consultancy fees, honorarium, travel support and speaker fees from Bayer, Novartis, Boehringer Ingelheim, Roche, Topcon and Carl Zeiss AG, outside the submitted work. Member of the Eye editorial board. PL: Consultant for Aerie, AbbVie, Apellis, Bausch & Lomb, Bayer, Biogen, Boehringer Ingelheim, Genentech, Novartis, Ocular Therapeutix, Outlook Therapeutics and Roche. BE: Consultant for Allergan, Bayer, Novartis and Roche. AJ: Personal fees from Novartis, Bayer HealthCare Pharmaceuticals, Allergan and Boehringer Ingelheim, as well as grants from Novartis and Bayer HealthCare Pharmaceuticals. AK: AbbVie, Alcon, Apellis, Bayer, Boehringer Mannheim, Carl Zeiss Meditec, Heidelberg, Janssen, Nikon-Optos, Novartis, Roche and Topcon. J-FK: Consultant for Allergan/AbbVie, Apellis, Bayer, Carl Zeiss Meditec, Janssen, Nano Retina, Roche and Théa, and is a member of the Data and Safety Monitoring Boards for Alexion and Novo Nordisk. XL: No financial interests to report. AL: Consultant for Allergan, Annexon, Bayer Healthcare, Beyeonics, Biogen, ForSight Labs, IQVIA, Iveric Bio, Johnson & Johnson, MJH Events, Nano Retina, Notal Vision, Novartis, Ocuphire Pharma, OcuTerra, OphtiMedRx, Roche, Ripple Therapeutics, Syneos, WebMD and Xbrane. ML-A: Consultant for Allergan/AbbVie, Apellis, Bayer, Novartis, Roche and Santen. RN: Honoraria for consultancy and lecture fees from Bayer HealthCare Pharmaceuticals and Allergan. AAO: Personal fees from AbbVie Japan, Inc., grants and personal fees from Alcon Pharma KK (Japan), personal fees from Astellas Japan, personal fees from Bayer AG, grants and personal fees from Bayer Yakuhin Ltd. (Japan), personal fees from Daiichi-Sankyo, grants and personal fees from Mitsubishi Tanabe Pharma Corporation, personal fees from Senju Pharmaceutical Co., Ltd., and grants and personal fees from Santen Pharmaceutical Co. Ltd. (Japan). IP: Consultancy, travel and speaker fees from Allergan, Bayer, Novartis and Roche. FR: Consultant for Bayer, Iveric Bio, Johnson & Johnson, Novartis and Roche. DW: Consultant for AbbVie, Alcon, Apellis, Bayer, Bausch Health, Biogen, Boehringer Ingelheim, Novartis, Ripple Therapeutics, Roche, Topcon and Zeiss, has received financial support (to institution) from Bayer, Novartis and Roche, and is an equity owner at ArcticDx. LW: Consultant for Bayer, Lumibird Medical, Novartis and Roche. DZ: Received grants from Roche, has served on scientific advisory boards for AbbVie, Allergan, Bayer, Johnson & Johnson, Novartis and Roche, and has been a speaker for AbbVie, Allergan, Bayer, Novartis and Roche. JZ-V: Received grants from AbbVie, Allergan, Bayer, Novartis and Roche, has served on scientific advisory boards for AbbVie, Allergan, Bayer, Novartis and Roche, and has been a speaker for AbbVie, Alcon, Alimera Sciences, Allergan, Bausch & Lomb, Bayer, Brill Pharma, DORC, Esteve, Novartis, Roche, Topcon Healthcare and Zeiss. Member of the Eye editorial board. PM: Received consulting fees from Allergan, Apellis, Bayer, Novartis, and Roche, lecture honoraria from Bayer, support for attending meetings and/or travel from Bayer and Roche, and he is a member of data safety monitoring boards or advisory boards for Apellis and Bayer. VC: Advisory board member for Alcon, Roche, Bayer, Novartis, Apellis and Boehringer Ingelheim, and received grants from Bayer, Novartis and Roche. Member of the Eye editorial board.

Figures

Fig. 1
Fig. 1. Algorithm for the treatment of nAMD.
nAMD neovascular age-related macular degeneration, T&E treat-and-extend.
Fig. 2
Fig. 2. T&E interval criteria: ALTAIR versus traditional.
aAs assessed by OCT. bLoss of ≥5 ETDRS letters from the last treatment visit in conjunction with recurrent fluid on OCT. cIncrease in CRT of ≥100 μm compared with the lowest previous value on OCT. CRT central retinal thickness, ETDRS Early Treatment Diabetic Retinopathy Study, IRF intraretinal fluid, nAMD neovascular age-related macular degeneration, OCT optical coherence tomography, SRF subretinal fluid, T&E treat-and-extend.
See this image and copyright information in PMC

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