Treatment Patterns and Visual Outcomes during the Maintenance Phase of Treat-and-Extend Therapy for Age-Related Macular Degeneration

Rohan W. Essex, Vuong Nguyen, Richard Walton, Jennifer J. Arnold, Ian L McAllister, Robyn H. Guymer, Nigel Morlet, Stephanie Young, Daniel Barthelmes, Mark C. Gillies, Fight Retinal Blindness Study Group

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16 Citations (Scopus)

Abstract

Purpose To present the treatment patterns, disease activity, and visual outcomes of eyes in the maintenance phase of a treat-and-extend regimen for neovascular age-related macular degeneration (nAMD). To compare the maintenance phase behavior of eyes with a shorter induction phase (≤3 injections) with those requiring a longer induction phase (>3 injections). Design Database observational study. Participants Eyes with nAMD receiving anti-vascular endothelial growth factor (VEGF) treatment using a treat-and-extend protocol. Persistently active eyes were excluded, as were eyes with <12 months follow-up during the maintenance phase. Methods Clinical information from a large prospective international voluntary registry of nAMD was analyzed. The maintenance phase was defined as starting at the first clinician-reported grading of lesion inactivity. Main Outcome Measures For analyses by eye: treatment interval at first reactivation; time to first reactivation; and visual acuity change during the study period. For analyses by visit: choroidal neovascular membrane activity graded by the treating physician; time since previous injection; and visual acuity loss since previous injection (>0 letters and ≥15 letters). Results The mean change in visual acuity during the maintenance phase was +1.0 letters at 12 months −0.6 letters at 24 months and −1.5 at 36 months. Median treatment interval increased from 35 days at study entry to 63 days at 12 months and was 60 days at 36 months. 38.5% of eyes remained inactive at all observed visits during the maintenance phase (minimum 1 year follow-up, mean 945 days). The most common treatment interval at first reactivation was 8 weeks. Treatment intervals beyond 12 weeks seemed to be associated with increased risk of disease reactivation, with risk of reactivation reaching 37.4% at treatment intervals of ≥20 weeks. Eyes with a longer induction phase had worse visual outcomes in the maintenance phase, and earlier and more-frequent disease reactivation, although they received injections less frequently. Conclusions The detailed behavior of eyes in the maintenance phase of treat-and-extend management for nAMD is presented. Visual acuity was well maintained during the study period. The most common interval at which reactivation first occurred was 8 weeks. Longer duration of induction phase was associated with worse visual acuity outcomes and earlier disease reactivation, perhaps because of undertreatment.

Original languageEnglish
Pages (from-to)2393-2400
Number of pages8
JournalOphthalmology
Volume123
Issue number11
DOIs
Publication statusPublished - 1 Nov 2016
Externally publishedYes

Cite this

Essex, R. W., Nguyen, V., Walton, R., Arnold, J. J., McAllister, I. L., Guymer, R. H., ... Fight Retinal Blindness Study Group (2016). Treatment Patterns and Visual Outcomes during the Maintenance Phase of Treat-and-Extend Therapy for Age-Related Macular Degeneration. Ophthalmology, 123(11), 2393-2400. https://doi.org/10.1016/j.ophtha.2016.07.012
Essex, Rohan W. ; Nguyen, Vuong ; Walton, Richard ; Arnold, Jennifer J. ; McAllister, Ian L ; Guymer, Robyn H. ; Morlet, Nigel ; Young, Stephanie ; Barthelmes, Daniel ; Gillies, Mark C. ; Fight Retinal Blindness Study Group. / Treatment Patterns and Visual Outcomes during the Maintenance Phase of Treat-and-Extend Therapy for Age-Related Macular Degeneration. In: Ophthalmology. 2016 ; Vol. 123, No. 11. pp. 2393-2400.
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title = "Treatment Patterns and Visual Outcomes during the Maintenance Phase of Treat-and-Extend Therapy for Age-Related Macular Degeneration",
abstract = "Purpose To present the treatment patterns, disease activity, and visual outcomes of eyes in the maintenance phase of a treat-and-extend regimen for neovascular age-related macular degeneration (nAMD). To compare the maintenance phase behavior of eyes with a shorter induction phase (≤3 injections) with those requiring a longer induction phase (>3 injections). Design Database observational study. Participants Eyes with nAMD receiving anti-vascular endothelial growth factor (VEGF) treatment using a treat-and-extend protocol. Persistently active eyes were excluded, as were eyes with <12 months follow-up during the maintenance phase. Methods Clinical information from a large prospective international voluntary registry of nAMD was analyzed. The maintenance phase was defined as starting at the first clinician-reported grading of lesion inactivity. Main Outcome Measures For analyses by eye: treatment interval at first reactivation; time to first reactivation; and visual acuity change during the study period. For analyses by visit: choroidal neovascular membrane activity graded by the treating physician; time since previous injection; and visual acuity loss since previous injection (>0 letters and ≥15 letters). Results The mean change in visual acuity during the maintenance phase was +1.0 letters at 12 months −0.6 letters at 24 months and −1.5 at 36 months. Median treatment interval increased from 35 days at study entry to 63 days at 12 months and was 60 days at 36 months. 38.5{\%} of eyes remained inactive at all observed visits during the maintenance phase (minimum 1 year follow-up, mean 945 days). The most common treatment interval at first reactivation was 8 weeks. Treatment intervals beyond 12 weeks seemed to be associated with increased risk of disease reactivation, with risk of reactivation reaching 37.4{\%} at treatment intervals of ≥20 weeks. Eyes with a longer induction phase had worse visual outcomes in the maintenance phase, and earlier and more-frequent disease reactivation, although they received injections less frequently. Conclusions The detailed behavior of eyes in the maintenance phase of treat-and-extend management for nAMD is presented. Visual acuity was well maintained during the study period. The most common interval at which reactivation first occurred was 8 weeks. Longer duration of induction phase was associated with worse visual acuity outcomes and earlier disease reactivation, perhaps because of undertreatment.",
author = "Essex, {Rohan W.} and Vuong Nguyen and Richard Walton and Arnold, {Jennifer J.} and McAllister, {Ian L} and Guymer, {Robyn H.} and Nigel Morlet and Stephanie Young and Daniel Barthelmes and Gillies, {Mark C.} and {Fight Retinal Blindness Study Group}",
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Essex, RW, Nguyen, V, Walton, R, Arnold, JJ, McAllister, IL, Guymer, RH, Morlet, N, Young, S, Barthelmes, D, Gillies, MC & Fight Retinal Blindness Study Group 2016, 'Treatment Patterns and Visual Outcomes during the Maintenance Phase of Treat-and-Extend Therapy for Age-Related Macular Degeneration', Ophthalmology, vol. 123, no. 11, pp. 2393-2400. https://doi.org/10.1016/j.ophtha.2016.07.012

Treatment Patterns and Visual Outcomes during the Maintenance Phase of Treat-and-Extend Therapy for Age-Related Macular Degeneration. / Essex, Rohan W.; Nguyen, Vuong; Walton, Richard; Arnold, Jennifer J.; McAllister, Ian L; Guymer, Robyn H.; Morlet, Nigel; Young, Stephanie; Barthelmes, Daniel; Gillies, Mark C.; Fight Retinal Blindness Study Group.

In: Ophthalmology, Vol. 123, No. 11, 01.11.2016, p. 2393-2400.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Treatment Patterns and Visual Outcomes during the Maintenance Phase of Treat-and-Extend Therapy for Age-Related Macular Degeneration

AU - Essex, Rohan W.

AU - Nguyen, Vuong

AU - Walton, Richard

AU - Arnold, Jennifer J.

AU - McAllister, Ian L

AU - Guymer, Robyn H.

AU - Morlet, Nigel

AU - Young, Stephanie

AU - Barthelmes, Daniel

AU - Gillies, Mark C.

AU - Fight Retinal Blindness Study Group

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Purpose To present the treatment patterns, disease activity, and visual outcomes of eyes in the maintenance phase of a treat-and-extend regimen for neovascular age-related macular degeneration (nAMD). To compare the maintenance phase behavior of eyes with a shorter induction phase (≤3 injections) with those requiring a longer induction phase (>3 injections). Design Database observational study. Participants Eyes with nAMD receiving anti-vascular endothelial growth factor (VEGF) treatment using a treat-and-extend protocol. Persistently active eyes were excluded, as were eyes with <12 months follow-up during the maintenance phase. Methods Clinical information from a large prospective international voluntary registry of nAMD was analyzed. The maintenance phase was defined as starting at the first clinician-reported grading of lesion inactivity. Main Outcome Measures For analyses by eye: treatment interval at first reactivation; time to first reactivation; and visual acuity change during the study period. For analyses by visit: choroidal neovascular membrane activity graded by the treating physician; time since previous injection; and visual acuity loss since previous injection (>0 letters and ≥15 letters). Results The mean change in visual acuity during the maintenance phase was +1.0 letters at 12 months −0.6 letters at 24 months and −1.5 at 36 months. Median treatment interval increased from 35 days at study entry to 63 days at 12 months and was 60 days at 36 months. 38.5% of eyes remained inactive at all observed visits during the maintenance phase (minimum 1 year follow-up, mean 945 days). The most common treatment interval at first reactivation was 8 weeks. Treatment intervals beyond 12 weeks seemed to be associated with increased risk of disease reactivation, with risk of reactivation reaching 37.4% at treatment intervals of ≥20 weeks. Eyes with a longer induction phase had worse visual outcomes in the maintenance phase, and earlier and more-frequent disease reactivation, although they received injections less frequently. Conclusions The detailed behavior of eyes in the maintenance phase of treat-and-extend management for nAMD is presented. Visual acuity was well maintained during the study period. The most common interval at which reactivation first occurred was 8 weeks. Longer duration of induction phase was associated with worse visual acuity outcomes and earlier disease reactivation, perhaps because of undertreatment.

AB - Purpose To present the treatment patterns, disease activity, and visual outcomes of eyes in the maintenance phase of a treat-and-extend regimen for neovascular age-related macular degeneration (nAMD). To compare the maintenance phase behavior of eyes with a shorter induction phase (≤3 injections) with those requiring a longer induction phase (>3 injections). Design Database observational study. Participants Eyes with nAMD receiving anti-vascular endothelial growth factor (VEGF) treatment using a treat-and-extend protocol. Persistently active eyes were excluded, as were eyes with <12 months follow-up during the maintenance phase. Methods Clinical information from a large prospective international voluntary registry of nAMD was analyzed. The maintenance phase was defined as starting at the first clinician-reported grading of lesion inactivity. Main Outcome Measures For analyses by eye: treatment interval at first reactivation; time to first reactivation; and visual acuity change during the study period. For analyses by visit: choroidal neovascular membrane activity graded by the treating physician; time since previous injection; and visual acuity loss since previous injection (>0 letters and ≥15 letters). Results The mean change in visual acuity during the maintenance phase was +1.0 letters at 12 months −0.6 letters at 24 months and −1.5 at 36 months. Median treatment interval increased from 35 days at study entry to 63 days at 12 months and was 60 days at 36 months. 38.5% of eyes remained inactive at all observed visits during the maintenance phase (minimum 1 year follow-up, mean 945 days). The most common treatment interval at first reactivation was 8 weeks. Treatment intervals beyond 12 weeks seemed to be associated with increased risk of disease reactivation, with risk of reactivation reaching 37.4% at treatment intervals of ≥20 weeks. Eyes with a longer induction phase had worse visual outcomes in the maintenance phase, and earlier and more-frequent disease reactivation, although they received injections less frequently. Conclusions The detailed behavior of eyes in the maintenance phase of treat-and-extend management for nAMD is presented. Visual acuity was well maintained during the study period. The most common interval at which reactivation first occurred was 8 weeks. Longer duration of induction phase was associated with worse visual acuity outcomes and earlier disease reactivation, perhaps because of undertreatment.

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U2 - 10.1016/j.ophtha.2016.07.012

DO - 10.1016/j.ophtha.2016.07.012

M3 - Article

VL - 123

SP - 2393

EP - 2400

JO - Ophthalmology

JF - Ophthalmology

SN - 0161-6420

IS - 11

ER -