title: Aflibercept in wet AMD beyond the first year of treatment: recommendations by an expert roundtable panel.
abstract: This paper provides expert recommendations on administration of aflibercept in wet age-related macular degeneration (AMD) after Year 1 (Y1), based on a roundtable discussion held in London, UK in November 2014. The goals of treatment after Y1 are to maintain visual and anatomical gains whilst minimising treatment burden and using resources effectively. The treatment decision should be made at the seventh injection visit (assuming the label has been followed) in Y1, and three approaches are proposed: (a) eyes with active disease on imaging/examination but with stable visual acuity (VA) at the end of Y1 should continue with fixed 8-weekly dosing; (b) eyes with inactive disease on imaging/examination and stable VA should be managed using a 'treat and extend' (T&E) regimen. T&E involves treating and then extending the interval until the next treatment, by 2-week intervals, to a maximum of 12 weeks, provided the disease remains inactive. If there is new evidence of disease activity, treatment is administered and the interval to the next treatment shortened; and (c) if there has been no disease activity for ≥3 consecutive visits, a trial of monitoring without treatment may be appropriate, initiated at the end of Y1 or at any time during Y2. Where possible, VA testing, OCT imaging and injection should be performed at the same visit. The second eye should be monitored to detect fellow eye involvement. In bilateral disease, the re-treatment interval should be driven by the better-seeing eye or, if the VA is similar, the eye with the more active disease.
authors.affiliation: Ophthalmology Department, St James's University Hospital, Leeds, UK.
authors.forename: M
authors.initials: M
authors.lastname: McKibbin
authors.affiliation: Ophthalmology Department, Bradford Royal Infirmary, Bradford, UK.
authors.forename: H
authors.initials: H
authors.lastname: Devonport
authors.affiliation: Ophthalmology Department, The York Hospital, York, UK.
authors.forename: R
authors.initials: R
authors.lastname: Gale
authors.affiliation: Ophthalmology Department, NHS Greater Glasgow and Clyde, UK.
authors.forename: M
authors.initials: M
authors.lastname: Gavin
authors.affiliation: Southampton General Hospital, Southampton, UK.
authors.forename: A
authors.initials: A
authors.lastname: Lotery
authors.affiliation: 1] Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK [2] Centre for Ophthalmology & Vision Sciences, Institute of Human Development, University of Manchester, Manchester, UK.
authors.forename: S
authors.initials: S
authors.lastname: Mahmood
authors.affiliation: NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.
authors.forename: P J
authors.initials: PJ
authors.lastname: Patel
authors.affiliation: Bristol Eye Hospital, Bristol, UK.
authors.forename: A
authors.initials: A
authors.lastname: Ross
authors.affiliation: NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Sivaprasad
authors.affiliation: Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: J
authors.initials: J
authors.lastname: Talks
authors.affiliation: Department of Ophthalmology, Harrogate District Hospital, Harrogate, UK.
authors.forename: G
authors.initials: G
authors.lastname: Walters
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D006801:Humans; D058449:Intravitreal Injections; D040262:Receptors, Vascular Endothelial Growth Factor / Q000627:therapeutic use*; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D014792:Visual Acuity; D057135:Wet Macular Degeneration / Q000188:drug therapy*
chemical_list: D020533:Angiogenesis Inhibitors; D011993:Recombinant Fusion Proteins; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor