TY - JOUR
T1 - Efficacy, safety, and treatment burden of treat-and-extend versus alternative anti-VEGF regimens for nAMD
T2 - a systematic review and meta-analysis
AU - Rosenberg, Daniel
AU - Deonarain, Deven M.
AU - Gould, Jonah
AU - Sothivannan, Amirthan
AU - Phillips, Mark R.
AU - Sarohia, Gurkaran S.
AU - Sivaprasad, Sobha
AU - Wykoff, Charles C.
AU - Cheung, Chui Ming Gemmy
AU - Sarraf, David
AU - Bakri, Sophie J.
AU - Chaudhary, Varun
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to The Royal College of Ophthalmologists.
PY - 2023/1
Y1 - 2023/1
N2 - 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.
AB - 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.
KW - Humans
KW - Angiogenesis Inhibitors/therapeutic use
KW - Vascular Endothelial Growth Factor A
KW - Ranibizumab
KW - Receptors, Vascular Endothelial Growth Factor
KW - Clinical Protocols
KW - Intravitreal Injections
KW - Treatment Outcome
KW - Recombinant Fusion Proteins/therapeutic use
KW - Wet Macular Degeneration/drug therapy
KW - Randomized Controlled Trials as Topic
UR - http://www.scopus.com/inward/record.url?scp=85127636500&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85127636500&partnerID=8YFLogxK
U2 - 10.1038/s41433-022-02020-7
DO - 10.1038/s41433-022-02020-7
M3 - Review article
C2 - 35396574
AN - SCOPUS:85127636500
SN - 0950-222X
VL - 37
SP - 6
EP - 16
JO - Eye (Basingstoke)
JF - Eye (Basingstoke)
IS - 1
ER -