Treat-and-extend versus alternate dosing strategies with anti-vascular endothelial growth factor agents to treat center involving diabetic macular edema: A systematic review and meta-analysis of 2,346 eyes

Gurkaran S. Sarohia, Keean Nanji, Mohammad Khan, Muhammad F. Khalid, Daniel Rosenberg, Deven M. Deonarain, Mark R. Phillips, Lehana Thabane, Peter K. Kaiser, Sunir J. Garg, Sobha Sivaprasad, Charles C. Wykoff, Varun Chaudhary

Research output: Contribution to journalReview articlepeer-review

Abstract

Anti-vascular endothelial growth factor (Anti-VEGF) agents are the standard of care for diabetic macular edema (CI-DME) with vision loss. They are commonly administered using several treatment protocols, including fixed, pro re nata (PRN) and treat-and-extend (T&E) regimens. Because of the lack of evidence defining an ideal treatment paradigm, we systematically compared T&E with fixed or PRN regimens. Visual acuity improvement was similar when comparing T&E to fixed or PRN dosing at 12 and 24 months. Regarding anatomic outcomes, no significant difference was found between T&E and fixed regimens for central retinal thickness or central subfoveal thickness at 12 and 24 months. Similarly, no significant difference was found for central retinal thickness at 12 months for T&E versus PRN regimen. Regarding total number of injections, no significant difference existed between T&E versus fixed regimens at 12 months. PRN regimens delivered fewer injections compared to T&E regimens at 12 months. The results of this analysis support that visual acuity and anatomic outcomes at 12 and 24 months are similar between T&E with either fixed or PRN regimens. More head-to-head trials comparing T&E versus fixed and PRN dosing are needed to provide visual and functional outcome data beyond year 2. PROSPERO Registration: CRD42021249362.

Original languageEnglish (US)
JournalSurvey of Ophthalmology
DOIs
StateAccepted/In press - 2022

Keywords

  • Aflibercept
  • Diabetes
  • Diabetic macular edema
  • Diabetic retinopathy
  • Faricimab
  • Intravitreal anti-VEGF
  • Ranibizumab
  • Retina
  • Vascular endothelial growth factor
  • VEGF

ASJC Scopus subject areas

  • Ophthalmology

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