title: Changing from a pro re nata treatment regimen to a treat and extend regimen with ranibizumab in neovascular age-related macular degeneration.
abstract: BACKGROUND
  Treat and extend (TE) treatment regimens have the potential to reduce the treatment burden placed upon patients receiving ranibizumab for neovascular age-related macular degeneration (nAMD). This study aimed to analyse changes in best corrected visual acuity (BCVA) and anatomical parameters in patients switching from a pro re nata (PRN) to a TE regimen during routine clinical practice.
  
  
  METHODS
  Retrospective, consecutive, comparative case series of treatment-naïve patients who were initially treated with 0.5 mg ranibizumab according to a PRN schedule, and subsequently switched to a TE schedule (12-month follow-up).
  
  
  RESULTS
  146 eyes from 134 consecutive treatment-naïve patients were included. Mean BCVA (decimal±SD) increased from 0.39±0.23 to 0.55±0.22 (p<0.001) during the PRN loading regimen, declining to 0.49±0.22 (p<0.001) during the PRN maintenance phase (mean duration 17 months; range 3-55). Following the switch to TE, BCVA improved to 0.55±0.23 and 0.56±0.24 by 6 and 12 months, respectively (p<0.001). Mean intraindividual variance in BCVA was higher during the PRN phase than at 12 months for TE (0.30±0.18 vs 0.09±0.08, respectively; p<0.001). After switching to TE, mean central retinal thickness decreased from 355±112 µm to 330±105 and 320±103 µm at 6 and 12 months, respectively (p<0.001). Mean number of visits per month was higher during PRN than TE periods (1.05±0.13 vs 0.73±0.18; respectively; p<0.001).
  
  
  CONCLUSIONS
  A TE regimen can improve and stabilise patient outcomes in nAMD compared with PRN, with the potential to reduce the healthcare resource burden incurred from fixed monitoring requirements.
authors.affiliation: Vista Klinik, Binningen, Switzerland Department of Ophthalmology, Kantonsspital Liestal, Liestal, Switzerland University of Basel, Basel, Switzerland.
authors.forename: Katja
authors.initials: K
authors.lastname: Hatz
authors.affiliation: Vista Klinik, Binningen, Switzerland Department of Ophthalmology, Kantonsspital Liestal, Liestal, Switzerland University of Basel, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Prünte
mesh_terms: D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D002985:Clinical Protocols; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D011446:Prospective Studies; D000069579:Ranibizumab / Q000008:administration & dosage*; D015861:Retinal Neovascularization / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D000069579:Ranibizumab
keywords: Degeneration; Macula