Researches based in Canada, UK, Singapore and the USA has reported a comprehensive systematic review and meta analyses on the comparison of anti-VEGF regimens to treat neovascular age-related macular degeneration (nAMD). The study suggests that at 12 and 24 months T&E (“treat-and-extend”) therapy preserves visual acuity, similar to fixed schedules, “while exerting significantly lower treatment burden, regardless of anti-VEGF agent used”. The study also showed that T&E treatment was found to deliver superior visual acuity outcomes relative to pro re nata (PRN) at 12 or 24 months. The current synthesis of the data assesses the efficacy, safety, and treatment burden of T&E aflibercept and ranibizumab, compared against alternative dosing regimens.
The international research team identified over 9,450 references in the systematic research, condensing a total of 15 full-length manuscripts, one conference abstract, and six trial registries, consulted for extraction. In summary, the study provided “the largest evidence synthesis to date in terms of efficacy and treatment burden of T&E versus fixed dosing and PRN paradigm in management of nAMD”. The effect size estimates demonstrated that T&E is non-inferior to gold standard fixed dosing regimens while reducing treatment burden at month 12 and 24. In addition, T&E resulted in statistically superior visual outcomes relative to PRN paradigm at month 12 and 24.
In their analyses, the detailed data showed that VA improvement was similar with T&E and fixed dosing at 12 months (MD −0.08 letters, p = 0.95) and 24 months (MD 0.58 letters, p = 0.62). In contrast, the results showed that VA improvements were significantly greater for T&E when compared against a PRN regimen at 12 months (MD 3.95 letters, p < 0.0001) and 24 months (MD 4.08 letters, p < 0.001). In addition, significantly fewer ranibizumab injections were administered in the T&E arm at 12 months (MD –2.42 injections, p < 0.0001) and 24 months (MD –6.06 injections, p < 0.00001), relative to fixed dosing. Finally, fewer aflibercept injections were likewise administered to patients on a T&E regimen versus fixed dosing at 12 months (MD –0.78 injections, p < 0.0001). The research team commented that “the present synthesis implies that T&E preserves VA similar to fixed schedules with significantly fewer injections at one and two years”.