TY - JOUR
T1 - Treat-and-extend versus alternate dosing strategies with anti-vascular endothelial growth factor agents to treat center involving diabetic macular edema
T2 - A systematic review and meta-analysis of 2,346 eyes
AU - Sarohia, Gurkaran S.
AU - Nanji, Keean
AU - Khan, Mohammad
AU - Khalid, Muhammad F.
AU - Rosenberg, Daniel
AU - Deonarain, Deven M.
AU - Phillips, Mark R.
AU - Thabane, Lehana
AU - Kaiser, Peter K.
AU - Garg, Sunir J.
AU - Sivaprasad, Sobha
AU - Wykoff, Charles C.
AU - Chaudhary, Varun
N1 - Funding Information:
This study was not funded by any internal or external sources, and represents original work never presented previously. Dr. Chaudhary reports grants and other from Novartis, grants and other from Bayer, grants from Allergan, and is a scientific advisory board member for Novartis, Bayer and Roche outside the submitted work. Dr Wykoff reported consulting for Acuela, Adverum Biotechnologies, Inc, Aerpio, Alimera Sciences, Allegro Ophthalmics, LLC, Allergan, Apellis Pharmaceuticals, Bayer AG, Chengdu Kanghong Pharmaceuticals Group Co, Ltd, Clearside Biomedical, DORC (Dutch Ophthalmic Research Center), EyePoint Pharmaceuticals, Gentech/Roche, GyroscopeTx, IVERIC bio, Kodiak Sciences Inc, Novartis AG, ONL Therapeutics, Oxurion NV, PolyPhotonix, Recens Medical, Regeron Pharmaceuticals, Inc, REGENXBIO Inc, Santen Pharmaceutical Co, Ltd, and Takeda Pharmaceutical Company Limited and receiving research funding from Adverum Biotechnologies, Inc, Aerie Pharmaceuticals, Inc, Aerpio, Alimera Sciences, Allergan, Apellis Pharmaceuticals, Chengdu Kanghong Pharmaceutical Group Co, Ltd, Clearside Biomedical, Gemini Therapeutics, Genentech/Roche, Graybug Vision, Inc, GyroscopeTx, Ionis Pharmaceuticals, IVERIC bio, Kodiak Sciences Inc, Neurotech LLC, Novartis AG, Opthea, Outlook Therapeutics, Inc, Recens Medical, Regeneron Pharmaceuticals, Inc, REGENXBIO Inc, Samsung Pharm Co, Ltd, Santen Pharmaceutical Co, Ltd, and Xbrane Biopharma AB. Dr. Sivaprasad reports receiving research grants from Novartis, Bayer, Allergan, Roche, Boehringer, Ingelheim and Optos Plc, Travel grants from Novartis, Bayer, speaker fees from Novartis, Bayer and Optos Plc, and attending advisory board meetings for Novartis, Bayer, Allergan, Roche, Boehringer, Ingelheim, Optos Plz, Oxurion, Ophthea, Apellis, Oculis and Heidelberg Engineering. Dr. Garg reports being a consultant for Allergan, Apellis, Bausch and Lomb, Boehringer Ingelheim, Johnson and Johnson and Kanaph. He also reports research grants from American Academy of Ophthalmology, Apellis, Boehringer Ingelheim, NGM Bio and Regeneron, outside the submitted work. Dr. Kaiser reports being a consultant for Novartis, Bayer, Regeneron, Kanghong, Allergan, RegenxBio. The remaining authors have no conflicts of interest to declare.
Funding Information:
Dr. Chaudhary reports grants and other from Novartis, grants and other from Bayer, grants from Allergan, and is a scientific advisory board member for Novartis, Bayer and Roche outside the submitted work. Dr Wykoff reported consulting for Acuela, Adverum Biotechnologies, Inc, Aerpio, Alimera Sciences, Allegro Ophthalmics, LLC, Allergan, Apellis Pharmaceuticals, Bayer AG, Chengdu Kanghong Pharmaceuticals Group Co, Ltd, Clearside Biomedical, DORC (Dutch Ophthalmic Research Center), EyePoint Pharmaceuticals, Gentech/Roche, GyroscopeTx, IVERIC bio, Kodiak Sciences Inc, Novartis AG, ONL Therapeutics, Oxurion NV, PolyPhotonix, Recens Medical, Regeron Pharmaceuticals, Inc, REGENXBIO Inc, Santen Pharmaceutical Co, Ltd, and Takeda Pharmaceutical Company Limited and receiving research funding from Adverum Biotechnologies, Inc, Aerie Pharmaceuticals, Inc, Aerpio, Alimera Sciences, Allergan, Apellis Pharmaceuticals, Chengdu Kanghong Pharmaceutical Group Co, Ltd, Clearside Biomedical, Gemini Therapeutics, Genentech/Roche, Graybug Vision, Inc, GyroscopeTx, Ionis Pharmaceuticals, IVERIC bio, Kodiak Sciences Inc, Neurotech LLC, Novartis AG, Opthea, Outlook Therapeutics, Inc, Recens Medical, Regeneron Pharmaceuticals, Inc, REGENXBIO Inc, Samsung Pharm Co, Ltd, Santen Pharmaceutical Co, Ltd, and Xbrane Biopharma AB. Dr. Sivaprasad reports receiving research grants from Novartis, Bayer, Allergan, Roche, Boehringer, Ingelheim and Optos Plc, Travel grants from Novartis, Bayer, speaker fees from Novartis, Bayer and Optos Plc, and attending advisory board meetings for Novartis, Bayer, Allergan, Roche, Boehringer, Ingelheim, Optos Plz, Oxurion, Ophthea, Apellis, Oculis and Heidelberg Engineering. Dr. Garg reports being a consultant for Allergan, Apellis, Bausch and Lomb, Boehringer Ingelheim, Johnson and Johnson and Kanaph. He also reports research grants from American Academy of Ophthalmology, Apellis, Boehringer Ingelheim, NGM Bio and Regeneron, outside the submitted work. Dr. Kaiser reports being a consultant for Novartis, Bayer, Regeneron, Kanghong, Allergan, RegenxBio. The remaining authors have no conflicts of interest to declare.
Publisher Copyright:
© 2022 Elsevier Ltd
PY - 2022/9/1
Y1 - 2022/9/1
N2 - 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.
AB - 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.
KW - Aflibercept
KW - Diabetes
KW - Diabetic macular edema
KW - Diabetic retinopathy
KW - Faricimab
KW - Intravitreal anti-VEGF
KW - Ranibizumab
KW - Retina
KW - VEGF
KW - Vascular endothelial growth factor
KW - Intravitreal Injections
KW - Humans
KW - Treatment Outcome
KW - Diabetes Mellitus
KW - Macular Edema/drug therapy
KW - Angiogenesis Inhibitors/therapeutic use
KW - Ranibizumab/therapeutic use
KW - Diabetic Retinopathy/complications
KW - Endothelial Growth Factors/therapeutic use
UR - http://www.scopus.com/inward/record.url?scp=85131536338&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85131536338&partnerID=8YFLogxK
U2 - 10.1016/j.survophthal.2022.04.003
DO - 10.1016/j.survophthal.2022.04.003
M3 - Review article
C2 - 35476929
AN - SCOPUS:85131536338
SN - 0039-6257
VL - 67
SP - 1346
EP - 1363
JO - Survey of Ophthalmology
JF - Survey of Ophthalmology
IS - 5
ER -