Treating Macular Disease: Issues To Remember

The investigators in Canada discovered that a treat-and-extend (T&E) regimen of administering ranibizumab to sufferers with neovascular age-related macular illness produced similar results to monthly dosing administrations, according to a study published inJAMA Ophthalmology.

Neovascular age-related macular degeneration is a principal cause of vision loss among elderly outpatients in developed nations, and there is currently no cure for the illness. However, ranibizumab, an anti-vascular endothelial growth factor agent, is widely used to treat the disease.

Administrate Medicine

In this randomized, open-label, multicenter, noninferiority intention-to-treat trial, 580 patients from 27 treatment centers in Canada were administered ranibizumab between May 2013 and August 2018. Sufferers were randomized to either a once-monthly dosing regimen or an extensive schedule of intravitreal medicines.

T&E regimens may vary among practitioners, but “the overall program includes a loading phase of monthly treatment followed by a maintenance phase,” researchers said. “After the loading phase, the interval between injections is progressively shortened or lengthened depending on the presence or absence of disease activity.”

When T&E is successfully implemented, it can reduce the burden of monthly injections, cut down on frequent assessment-related visits, and result in better recognition rates and visual outcomes.

The Research Outcomes

Mean variation in best-corrected visual acuity (BCVA) was measured in letters from baseline to month 24. The average age of participants was 78.8.

The research yielded the following conclusions:

• The T&E group had a mean of 17.6 injections and visits, compared with 23.5 in the monthly group, for a difference of 5.9 injections and visits (95% CI, 5.4-6.5; P <.001)
• Mean BCVA improvement with the T&E arm was 6.8 (14.1) letters versus 6.0 (12.6) letters with the monthly arm (difference, 0.9; 95% CI, −1.6 to 3.3; P = .21)
• A gain of 15 or more letters in 25.5% of the T&E group versus 23.1% of the monthly treatment group (difference, 2.4%; 95% CI, −6.8% to 11.6%; P = .59)
• A loss of 15 or more letters in 6.5% of the T&E group and 5.8% of the monthly treatment group (difference, −0.7%; 95% CI, −9.9% to 8.5%; P = .85)
• A gain of 10 or more letters was achieved by 42.9% of the T&E group versus 36.4% of the monthly group (difference, 6.4%; 95% CI, −2.9% to 15.5%; P = .18)

The investigators concluded that the study findings established the utility and effectiveness of T&E ranibizumab regimens and demonstrated that the T&E strategy is not worse than monthly regimens.

To Sum Up

The trial “confirmed that a treatment tailored to sufferers’ symptoms led to clinically meaningful advancements in BCVA (British Cattle Veterinary Association),” researchers said. “The T&E dosing regimen with ranibizumab achieved these results with fewer injections and visits, which has the potential to improve convenience and reduce the cost to the health care system compared with repeated dosing.”