Author: Mariano Cozzi
Co-authors: Davide Monteduro, Raffaele Esposito, Kimberly L. Spooner, Samantha Fraser-Bell, Giovanni Staurenghi, Francesco Romano, Matteo Airaldi, Andrew A. Chang, Alessandro Invernizzi
Abstract
Purpose: To compare the change in lesion area over 4-years of follow-up in eyes with neovascular age-related macular degeneration (nAMD) treated with anti-vascular endothelial growth factor (VEGF) agents using either a treat-and-extend (T&E) or a pro-re-nata (PRN) regimen in routine clinical practice.Setting/Venue: Two hundred-two patients with treatment-naïve nAMD from two different medical retina clinics: Sydney Retina Clinic, Sydney, Australia, and Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy.
Methods: This is a 4-year, multicenter, retrospective comparative study. Consecutive patients with nAMD received anti-VEGF therapy according to a T&E (n=105) or PRN (n=97) regimen. Eyes were included if they had received anti-VEGF injections for a period of at least 4-years and had baseline fluorescein angiography and annual optical coherence tomography (OCT) imaging using Heidelberg Spectralis. Two masked graders independently delineated the lesions margins from serial OCT images and growth rates were calculated. Main outcome measures included lesion area changes over 4-years, associated with
treatment strategy and the lesion activity.
Results: At baseline, the mean[SD] lesion area was 7.24[5.6] mm2 in the T&E group and 6.33[4.8] mm2 in the PRN group respectively (p=.22). After four years of treatment, the mean[SD] lesion area in the T&E group was 5.16[4.5] mm2 showing a significant reduction compared to baseline (p<.001). By contrast, the mean[SD] lesion area kept expanding in the PRN group during the follow-up and was 9.24[6.0] mm2 at four years, resulting significantly larger compared to baseline (p<.001). The lesion area at 4 years was significantly influenced by treatment regimen, baseline lesion area, and proportion of visits with active lesion. Eyes treated with a T&E approach had better visual outcomes compared to those in the PRN group and final visual acuity (VA) was significantly influenced by time, baseline VA and lesion area.
Conclusions: Eyes treated using a PRN “reactive” strategy had an increased lesion area and worse visual outcomes at four years, likely due to a higher proportion of visits with active disease during the follow-up. By contrast, the T&E regimen was associated with fewer recurrences of active disease, shrinkage of the lesion area and better vision at four years.
Financial Disclosures:
MC: Recipient: Carl Zeiss Meditec, Nidek, Novartis, Heidelberg Engineering.
DM: none
RAE: none
KLS: none
SFB: Consultant: Allergan, Apellis, Bayer, Novartis, Roche
GS: Consultant: Allergan, Apellis, Bayer HealthCare, Boehringer, Centervue, Chengdu Kanghong Biotechnology Co, Genentech, Heidelberg Engineering, Novartis, and Roche; Grant support: Carl Zeiss Meditec, Centervue, Heidelberg Engineering, Nidek, Optos, Optovue, Quantel Medical, and Topcon.
FR: none
MA: none
AC: Consultant: Allergan, Bayer, Novartis, Roche
AI: Consultant: Allergan, Bayer, Novartis.
