Two Year Outcomes of "Treat and Extend" Intravitreal Therapy Using Aflibercept Preferentially for Neovascular Age-Related Macular Degeneration

Daniel Barthelmes, Vuong Nguyen, Vincent Daien, Anna E. Campain, Richard Walton, Robyn Guymer, Nigel Morlet, Alex P. Hunyor, Rohan W. Essex, Jennifer J. Arnold, Mark C. Gillies, the Fight Retinal Blindness Study Group

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Abstract

PURPOSE:: To report 24-month outcomes of a treat and extend (T&E) regimen using aflibercept in eyes with neovascular age-related macular degeneration. METHODS:: This was a database observational study that included treatment-naive eyes with neovascular age-related macular degeneration tracked by the Fight Retinal Blindness! outcome registry completing 24 months of sole monotherapy with aflibercept treatment under a T&E regimen between November 1, 2012 and January 31, 2014. Locally weighted scatterplot smoothing curves were used to display visual acuity outcomes. Main outcome measures were change in visual acuity at 24 months and number of injections and visits during the study period. RESULTS:: The study population, identified by reviewing the database, consisted of 136 eyes from 123 patients completing 24 months of follow-up on aflibercept. Mean (SD) age was 77.2 (7.0) years, 59% were female. Mean visual acuity increased from 61.4 (∼20/60; SD 17.4) letters at baseline to 67.4 (∼20/45; SD 17.7) letters at 24 months (+6.0 letters [95% confidence interval: 3.3–8.5]; P < 0.001). From baseline to 24 months, the proportion of eyes with visual acuity ≥70 letters (20/40) increased (40%–58%, P < 0.001) and the proportion of eyes with visual acuity ≤35 letters (20/200) remained the same (10%; P = 0.547). Ninety-eight per cent of eyes starting with visual acuity ≥70 letters (20/40) were able to maintain this up to 24 months. From the first to the second year of treatment, the mean number of injections (7.8 [2.1] vs. 5.7 [2.6]; P < 0.001) and visits (8.7 [1.7] vs. 6.5 [2.4]; P < 0.001) decreased for eyes completing 24 months of treatment. When data from 60 eligible eyes that did not complete 2 years follow-up, along with 14 eyes that switched to ranibizumab, were included using last observation carried forward, the mean change in visual acuity from baseline was +5.6 letters (95% confidence interval: 3.3–7.7). CONCLUSION:: These data indicate that eyes treated with aflibercept, as a sole therapy, in routine clinical practice with a T&E regimen can achieve good visual outcomes while decreasing the burden of treatments and clinic visits.

Original languageEnglish
Pages (from-to)20-28
Number of pages9
JournalRetina-The Journal of Retinal and Vitreous Diseases
Volume38
Issue number1
DOIs
Publication statusPublished - Jan 2018
Externally publishedYes

Cite this

Barthelmes, Daniel ; Nguyen, Vuong ; Daien, Vincent ; Campain, Anna E. ; Walton, Richard ; Guymer, Robyn ; Morlet, Nigel ; Hunyor, Alex P. ; Essex, Rohan W. ; Arnold, Jennifer J. ; Gillies, Mark C. ; the Fight Retinal Blindness Study Group. / Two Year Outcomes of "Treat and Extend" Intravitreal Therapy Using Aflibercept Preferentially for Neovascular Age-Related Macular Degeneration. In: Retina-The Journal of Retinal and Vitreous Diseases. 2018 ; Vol. 38, No. 1. pp. 20-28.
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abstract = "PURPOSE:: To report 24-month outcomes of a treat and extend (T&E) regimen using aflibercept in eyes with neovascular age-related macular degeneration. METHODS:: This was a database observational study that included treatment-naive eyes with neovascular age-related macular degeneration tracked by the Fight Retinal Blindness! outcome registry completing 24 months of sole monotherapy with aflibercept treatment under a T&E regimen between November 1, 2012 and January 31, 2014. Locally weighted scatterplot smoothing curves were used to display visual acuity outcomes. Main outcome measures were change in visual acuity at 24 months and number of injections and visits during the study period. RESULTS:: The study population, identified by reviewing the database, consisted of 136 eyes from 123 patients completing 24 months of follow-up on aflibercept. Mean (SD) age was 77.2 (7.0) years, 59{\%} were female. Mean visual acuity increased from 61.4 (∼20/60; SD 17.4) letters at baseline to 67.4 (∼20/45; SD 17.7) letters at 24 months (+6.0 letters [95{\%} confidence interval: 3.3–8.5]; P < 0.001). From baseline to 24 months, the proportion of eyes with visual acuity ≥70 letters (20/40) increased (40{\%}–58{\%}, P < 0.001) and the proportion of eyes with visual acuity ≤35 letters (20/200) remained the same (10{\%}; P = 0.547). Ninety-eight per cent of eyes starting with visual acuity ≥70 letters (20/40) were able to maintain this up to 24 months. From the first to the second year of treatment, the mean number of injections (7.8 [2.1] vs. 5.7 [2.6]; P < 0.001) and visits (8.7 [1.7] vs. 6.5 [2.4]; P < 0.001) decreased for eyes completing 24 months of treatment. When data from 60 eligible eyes that did not complete 2 years follow-up, along with 14 eyes that switched to ranibizumab, were included using last observation carried forward, the mean change in visual acuity from baseline was +5.6 letters (95{\%} confidence interval: 3.3–7.7). CONCLUSION:: These data indicate that eyes treated with aflibercept, as a sole therapy, in routine clinical practice with a T&E regimen can achieve good visual outcomes while decreasing the burden of treatments and clinic visits.",
author = "Daniel Barthelmes and Vuong Nguyen and Vincent Daien and Campain, {Anna E.} and Richard Walton and Robyn Guymer and Nigel Morlet and Hunyor, {Alex P.} and Essex, {Rohan W.} and Arnold, {Jennifer J.} and Gillies, {Mark C.} and {the Fight Retinal Blindness Study Group}",
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Barthelmes, D, Nguyen, V, Daien, V, Campain, AE, Walton, R, Guymer, R, Morlet, N, Hunyor, AP, Essex, RW, Arnold, JJ, Gillies, MC & the Fight Retinal Blindness Study Group 2018, 'Two Year Outcomes of "Treat and Extend" Intravitreal Therapy Using Aflibercept Preferentially for Neovascular Age-Related Macular Degeneration', Retina-The Journal of Retinal and Vitreous Diseases, vol. 38, no. 1, pp. 20-28. https://doi.org/10.1097/IAE.0000000000001496

Two Year Outcomes of "Treat and Extend" Intravitreal Therapy Using Aflibercept Preferentially for Neovascular Age-Related Macular Degeneration. / Barthelmes, Daniel; Nguyen, Vuong; Daien, Vincent; Campain, Anna E.; Walton, Richard; Guymer, Robyn; Morlet, Nigel; Hunyor, Alex P.; Essex, Rohan W.; Arnold, Jennifer J.; Gillies, Mark C.; the Fight Retinal Blindness Study Group.

In: Retina-The Journal of Retinal and Vitreous Diseases, Vol. 38, No. 1, 01.2018, p. 20-28.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Two Year Outcomes of "Treat and Extend" Intravitreal Therapy Using Aflibercept Preferentially for Neovascular Age-Related Macular Degeneration

AU - Barthelmes, Daniel

AU - Nguyen, Vuong

AU - Daien, Vincent

AU - Campain, Anna E.

AU - Walton, Richard

AU - Guymer, Robyn

AU - Morlet, Nigel

AU - Hunyor, Alex P.

AU - Essex, Rohan W.

AU - Arnold, Jennifer J.

AU - Gillies, Mark C.

AU - the Fight Retinal Blindness Study Group

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N2 - PURPOSE:: To report 24-month outcomes of a treat and extend (T&E) regimen using aflibercept in eyes with neovascular age-related macular degeneration. METHODS:: This was a database observational study that included treatment-naive eyes with neovascular age-related macular degeneration tracked by the Fight Retinal Blindness! outcome registry completing 24 months of sole monotherapy with aflibercept treatment under a T&E regimen between November 1, 2012 and January 31, 2014. Locally weighted scatterplot smoothing curves were used to display visual acuity outcomes. Main outcome measures were change in visual acuity at 24 months and number of injections and visits during the study period. RESULTS:: The study population, identified by reviewing the database, consisted of 136 eyes from 123 patients completing 24 months of follow-up on aflibercept. Mean (SD) age was 77.2 (7.0) years, 59% were female. Mean visual acuity increased from 61.4 (∼20/60; SD 17.4) letters at baseline to 67.4 (∼20/45; SD 17.7) letters at 24 months (+6.0 letters [95% confidence interval: 3.3–8.5]; P < 0.001). From baseline to 24 months, the proportion of eyes with visual acuity ≥70 letters (20/40) increased (40%–58%, P < 0.001) and the proportion of eyes with visual acuity ≤35 letters (20/200) remained the same (10%; P = 0.547). Ninety-eight per cent of eyes starting with visual acuity ≥70 letters (20/40) were able to maintain this up to 24 months. From the first to the second year of treatment, the mean number of injections (7.8 [2.1] vs. 5.7 [2.6]; P < 0.001) and visits (8.7 [1.7] vs. 6.5 [2.4]; P < 0.001) decreased for eyes completing 24 months of treatment. When data from 60 eligible eyes that did not complete 2 years follow-up, along with 14 eyes that switched to ranibizumab, were included using last observation carried forward, the mean change in visual acuity from baseline was +5.6 letters (95% confidence interval: 3.3–7.7). CONCLUSION:: These data indicate that eyes treated with aflibercept, as a sole therapy, in routine clinical practice with a T&E regimen can achieve good visual outcomes while decreasing the burden of treatments and clinic visits.

AB - PURPOSE:: To report 24-month outcomes of a treat and extend (T&E) regimen using aflibercept in eyes with neovascular age-related macular degeneration. METHODS:: This was a database observational study that included treatment-naive eyes with neovascular age-related macular degeneration tracked by the Fight Retinal Blindness! outcome registry completing 24 months of sole monotherapy with aflibercept treatment under a T&E regimen between November 1, 2012 and January 31, 2014. Locally weighted scatterplot smoothing curves were used to display visual acuity outcomes. Main outcome measures were change in visual acuity at 24 months and number of injections and visits during the study period. RESULTS:: The study population, identified by reviewing the database, consisted of 136 eyes from 123 patients completing 24 months of follow-up on aflibercept. Mean (SD) age was 77.2 (7.0) years, 59% were female. Mean visual acuity increased from 61.4 (∼20/60; SD 17.4) letters at baseline to 67.4 (∼20/45; SD 17.7) letters at 24 months (+6.0 letters [95% confidence interval: 3.3–8.5]; P < 0.001). From baseline to 24 months, the proportion of eyes with visual acuity ≥70 letters (20/40) increased (40%–58%, P < 0.001) and the proportion of eyes with visual acuity ≤35 letters (20/200) remained the same (10%; P = 0.547). Ninety-eight per cent of eyes starting with visual acuity ≥70 letters (20/40) were able to maintain this up to 24 months. From the first to the second year of treatment, the mean number of injections (7.8 [2.1] vs. 5.7 [2.6]; P < 0.001) and visits (8.7 [1.7] vs. 6.5 [2.4]; P < 0.001) decreased for eyes completing 24 months of treatment. When data from 60 eligible eyes that did not complete 2 years follow-up, along with 14 eyes that switched to ranibizumab, were included using last observation carried forward, the mean change in visual acuity from baseline was +5.6 letters (95% confidence interval: 3.3–7.7). CONCLUSION:: These data indicate that eyes treated with aflibercept, as a sole therapy, in routine clinical practice with a T&E regimen can achieve good visual outcomes while decreasing the burden of treatments and clinic visits.

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