An expert panel of clinical ophthalmologists, assembled in London by Bayer HealthCare, has issued recommendations in relation to the administration of aflibercept (Eylea) in wet age-related macular degeneration (AMD) after year 1. The published findings coincide with an increasing number of patients completing their first year of treatment since the approval of aflibercept in the EU. The national roundtable was convened to discuss UK experience with aflibercept and to develop recommendations on the practical application of aflibercept after year 1. It is estimated there were 263,000 cases of wet AMD in the UK in the period 2007–2009, with an annual incidence of 39,700 new cases. Such numbers are expected to increase by over 30% by 2020. Consequently, clinical management of anti-VEGF treatment for wet AMD patients will continue to be of critical importance to the ophthalmic community.
In advance of the expert meeting, each participant was asked to complete a questionnaire to collate information on the number of wet AMD patients treated at the participant’s clinic, the treatment distribution in the clinic and the treatment approach employed at each stage of disease management (0 to 3 months, 3 to 11 months and >11 months). Participants were additionally requested to submit data on the use of aflibercept in year 1 at their institution, and share such data with all members of the panel at the meeting. Responses to the questionnaire and the collated data on use of the drug were used as the basis for the discussion on post-year 1 clinical management.
A paper detailing the recommendations, published in the journal Eye [(2015) 29, S1–S11; doi:10.1038/eye.2015.77] outlines the expert recommendations which follow the objective of maintaining visual and anatomical gains while minimizing treatment burden and an efficient use of limited resources. The panel recommended that the treatment decision by a clinician should be made at the seventh injection visit in year 1, at which point three approaches are proposed: (a) eyes with active disease (as assessed by imaging / examination) but with stable visual acuity (VA) at the end of the first year should continue with fixed 8-weekly dosing; (b) eyes with inactive disease and stable VA should be managed using a “treat and extend” regimen, unless new evidence of disease activity arises; and (c) if there is no disease activity for ≥3 consecutive visits, then the panel propose that a trial of monitoring without treatment may be appropriate (from the end of year 1). The panel additionally recommended that VA testing, OCT imaging and ocular injection should be preferably performed at the same visit.