Treat-and-Extend dosing of anti-VEGF therapy for retinal angiomatous proliferation

[MyVisionTest]

Treat and Extend is an effective dosing strategy for the treatment of
patients with retinal angiomatous proliferation, according to a new
study.

Since the first suggestion of a non-monthly dosing regimen in the
PrONTO study, many retinal specialists have moved toward dosing
individualization, with maintenance therapy provided on an as-needed
basis depending upon changes seen on optical coherence tomography
following an initial loading regimen. However, study data suggest that
better outcomes are achieved with more treatments and closer follow up
than are provided in most as-needed dosing regimens. The Treat and
Extend strategy differs from as-needed strategies in that it assumes a
predictable fluid-free interval. Injections are administered at this
interval, and then extended to slightly longer intervals as long as
there is no evidence of lesion reactivation. There is at present no
consensus on optimal anti-VEGF treatment and monitoring strategies,
but many clinicians prefer a variable dosing regimen over fixed
monthly injections to avoid unnecessary overtreatment.

Retinal angiomatous proliferation is a distinct form of
neovascularization that originates from the retina and extends
posteriorly into the subretinal space, eventually communicating in
some cases with new choroidal vessels. There is poor visual prognosis
because of extensive exudation and progression to poor vision is
common and often rapid.

This study was a retrospective analysis of visual acuity and optical
coherence tomography data of 11 eyes of 10 consecutive patients with
newly diagnosed retinal angiomatous proliferation treated with
intravitreal Avastin (bevacizumab) and/or Lucentis (ranibizumab) with
at least a 12-month follow-up. Three monthly injections were followed
by continued treatment at intervals increasing by 2 weeks per visit,
to a maximum of 10 weeks, unless clinical or optical coherence
tomography evidence of persistent or recurrent fluid was present, in
which case, the interval was shortened.

Mean baseline Snellen visual acuity was 20/80, improved to 20/40 at 1
month, and was maintained throughout the 36-month period (P < 0.04).
The mean center point optical coherence tomography thickness decreased
from 320 &micro;m to 180-230 &micro;m, and was maintained during the
study period (P < 0.02). The mean number of injections was 7 in the
first year, 6 in the second year, and 7 in the third year.

The investigators conclude that Treat and Extend anti-VEGF dosing in
retinal angiomatous proliferation delivers promising outcomes at a
reduced burden for the patient and health care system compared with
monthly and as-needed dosing regimens.

http://www.ncbi.nlm.nih.gov/pubmed/19898180

Retina. 2009 Nov-Dec;29(10):1424-31

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