This retrospective review examined recurrence of choroidal neovascularization (CNV) in patients who were weaned off a treat-and-extend anti-VEGF regimen for wet AMD.
Study design
The cohort comprised 385 eyes (321 patients) who were treated with anti-VEGF injections at 4-week intervals. If the macula remained “dry”, treatment was extended by 1- to 2-week intervals until the injections were 12 weeks apart. Treatment was stopped if there were no signs of disease activity, and reinitiated if there was new or recurrent CNV.
Outcomes
Approximately 37% of eyes (143 eyes of 120 patients) met criteria for treatment cessation over the average follow-up of 27 months. The overall recurrence rate was 29% (42 eyes of 36 patients) at a median of 14 months after stopping therapy.
Mean BCVA was 20/50 at the time of therapy cessation and 20/60 at the time of recurrence. However, most patients recovered their baseline vision after treatment was reinitiated.
Limitations
This is a retrospective study. While the majority of patients recovered vision, 6 out of 42 eyes lost more than 3 lines of vision. While 2 of those eyes achieved significant improvements in vision after restarting therapy, 4 eyes (3% of the total cohort) experienced significant and permanent vision loss.
Clinical significance
This study answers an important question for retina specialists: Are patients safely able to stop treatment if they are using a treat-and-extend protocol? The majority of patients still need to receive ongoing treatment as their disease remains active. However, in this series approximately 1/3 of patients were able to stop therapy for approximately 1 year.
With close and regular follow up, recurrence of disease can be managed successfully. However, patients should be counseled that some people may lose vision that may not be fully recoverable. Whether this outcome is unique to this protocol, or is part of the natural history of the disease has yet to be determined.