Treat-and-extend anti-VEGF regimen appears effective for wet AMD

This retrospective case series of wet AMD patients given intravitreal ranibizumab or bevacizumab found that the treat-and-extend regimen is effective at achieving and maintaining visual and anatomic improvements for up to three years.

The authors retrospectively examined outcomes in 196 patients (212 eyes) with treatment-naive wet AMD treated with either ranibizumab or bevacizumab for one to three years using a treat-and-extend regimen. They were then treated with monthly intravitreal injections of bevacizumab 1.25 mg or ranibizumab 0.5 mg until no signs of choroidal neovascularization (CNV) activity were detected on slit-lamp biomicroscopy and spectral-domain OCT; patient follow-ups and treatments were then extended by intervals of two weeks as long as no signs of CNV activity were present. However, if any signs of exudation were detected, treatment intervals were subsequently shortened by two-week intervals. Anti-VEGF treatment was administered at every visit, regardless of CNV activity.

Mean BCVA improved significantly after one year of treatment and was maintained at two and three years’ follow-up. Mean central retinal thickness significantly decreased at one year and was maintained at two and three years of follow up. Patients received, on average, 7.6, 5.7 and 5.8 injections over years one, two and three of treatment, respectively. At final follow-up, 94% of eyes had lost <3 lines of BCVA, and 34.4% of eyes had gained ≥3 lines of BCVA.

The authors conclude that wet AMD patients are able to maintain significant anatomic and visual improvements of greater than two lines of visual acuity, on average, for up to three years while undergoing intravitreal ranizibizumab or bevacizumab therapy with the treat-and-extend algorithm. They say this can be accomplished with fewer patient visits, injections and ancillary testing than patients receiving monthly treatments. Head-to-head studies are now needed to compare outcomes in wet AMD patients on treat-and-extend regimens with outcomes resulting from other regimens.