Efficacy, safety, and treatment burden of treat-and-extend versus alternative anti-VEGF regimens for nAMD: a systematic review and meta-analysis

Daniel Rosenberg, Deven M. Deonarain, Jonah Gould, Amirthan Sothivannan, Mark R. Phillips, Gurkaran S. Sarohia, Sobha Sivaprasad, Charles C. Wykoff, Chui Ming Gemmy Cheung, David Sarraf, Sophie J. Bakri, Varun Chaudhary

Research output: Contribution to journalReview articlepeer-review

24 Scopus citations


This study aimed to compare efficacy and treatment burden of treat-and-extend (T&E) anti-VEGF against fixed and pro re nata (PRN) regimens for neovascular age-related macular degeneration (nAMD). MEDLINE, CENTRAL, and EMBASE were searched. Randomized-controlled trials and observational studies comparing T&E to PRN or fixed dosing for treatment-naïve AMD patients were included. Mean difference (MD) for visual acuity (VA) and number of injections are presented. Risk of bias was assessed according to Cochrane guidelines. Methodology was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). VA improvement was similar with T&E and fixed dosing at one (MD −0.08 letters, p = 0.95) and two years (MD 0.58 letters, p = 0.62). In contrast, VA improvements were significantly greater for T&E when compared against a PRN regimen at one (MD 3.95 letters, p < 0.0001) and two years (MD 4.08 letters, p < 0.001). Significantly fewer ranibizumab injections were administered in the T&E arm at one (MD –2.42 injections, p < 0.0001) and two years (MD –6.06 injections, p < 0.00001) relative to fixed dosing. Fewer aflibercept injections were likewise administered to patients on a T&E regimen versus fixed dosing at one year (MD –0.78 injections, p < 0.0001). Low-certainty evidence from the present synthesis implies that T&E preserves VA similar to fixed schedules with significantly fewer injections at one and two years. Also, patients with T&E dosing achieved better VA outcomes than those on PRN regimen but T&E dosing was associated with more injections.

Original languageEnglish (US)
Pages (from-to)6-16
Number of pages11
JournalEye (Basingstoke)
Issue number1
StatePublished - Jan 2023


  • Humans
  • Angiogenesis Inhibitors/therapeutic use
  • Vascular Endothelial Growth Factor A
  • Ranibizumab
  • Receptors, Vascular Endothelial Growth Factor
  • Clinical Protocols
  • Intravitreal Injections
  • Treatment Outcome
  • Recombinant Fusion Proteins/therapeutic use
  • Wet Macular Degeneration/drug therapy
  • Randomized Controlled Trials as Topic

ASJC Scopus subject areas

  • Sensory Systems
  • Ophthalmology


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