• Anti-VEGF for Macular Edema: Monthly or Treat-and-Extend?

    By Lynda Seminara
    Selected By: Neil M. Bressler, MD, and Deputy Editors

    Journal Highlights

    JAMA Ophthalmology, April 2018

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    In a randomized clinical trial, the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) established that, in the first 6 months of treatment, bevacizumab, on average, does not result in inferior visual acuity (VA) out­comes when compared to aflibercept for managing macular edema from central retinal or hemiretinal vein occlusion.

    In a subsequent analysis of SCORE2 data among the participants who exhibited a good response to 6 months of monthly injections, Scott et al. compared monthly and treat-and-extend (TAE) regimens of aflibercept or bevacizumab. They found that TAE was associated with fewer injections and no meaningful differences in VA between the treatment schedules. Nonetheless, they advised that—because of the wide confidence intervals on VA differences between these 2 retreatment regimens —caution is warranted before conclud­ing that the 2 treatment schedules are associated with similar vision outcomes.

    For this analysis, participants with a protocol-defined good response to monthly injections in the first 6 months of SCORE2 continued on aflibercept or bevacizumab after random assign­ment to a monthly or TAE schedule. The primary outcome was difference in best-corrected VA letter score (VALS) from month 6 to month 12.

    At month 12 in the aflibercept arm, the mean VALS was 72.7 (approximately 20/40) in the monthly group (n = 79) and 71.6 (approximately 20/40) in the TAE group (n = 80), with a mean im­provement of 0.8 letters in the monthly group and a mean decline of 1.2 letters in the TAE group. The between-group difference in VALS change was 1.88 letters (97.5% confidence interval [CI], ‒1.07 to 4.83). At month 12 in the bevacizumab arm, mean VALS was 75.2 (approximately 20/32) in the monthly group (n = 67) and 74.0 (approximate­ly 20/32) in the TAE group (n = 67), with mean decreases of 1.6 and 0.4 letters, respectively. The between-group difference in VALS change was 1.98 letters (97.5% CI, ‒1.08 to 5.03 letters). In both treatment arms, more injec­tions were administered in the monthly group than the TAE group (aflibercept: 5.8 vs. 3.8 injections, respectively; beva­cizumab: 5.8 vs. 4.5 injections, respec­tively). (Also see related commentary by Jennifer K. Sun, MD, MPH, in the same issue.)

    The original article can be found here.