TWO YEAR OUTCOMES OF "TREAT AND EXTEND" INTRAVITREAL THERAPY USING AFLIBERCEPT PREFERENTIALLY FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.
OBJECTIVE
To report 24-month outcomes of a treat and extend (T&E) regimen using aflibercept in eyes with neovascular age-related macular degeneration.


METHODS
This was a database observational study that included treatment-naive eyes with neovascular age-related macular degeneration tracked by the Fight Retinal Blindness! outcome registry completing 24 months of sole monotherapy with aflibercept treatment under a T&E regimen between November 1, 2012 and January 31, 2014. Locally weighted scatterplot smoothing curves were used to display visual acuity outcomes. Main outcome measures were change in visual acuity at 24 months and number of injections and visits during the study period.


RESULTS
The study population, identified by reviewing the database, consisted of 136 eyes from 123 patients completing 24 months of follow-up on aflibercept. Mean (SD) age was 77.2 (7.0) years, 59% were female. Mean visual acuity increased from 61.4 (∼20/60; SD 17.4) letters at baseline to 67.4 (∼20/45; SD 17.7) letters at 24 months (+6.0 letters [95% confidence interval: 3.3-8.5]; P < 0.001). From baseline to 24 months, the proportion of eyes with visual acuity ≥70 letters (20/40) increased (40%-58%, P < 0.001) and the proportion of eyes with visual acuity ≤35 letters (20/200) remained the same (10%; P = 0.547). Ninety-eight per cent of eyes starting with visual acuity ≥70 letters (20/40) were able to maintain this up to 24 months. From the first to the second year of treatment, the mean number of injections (7.8 [2.1] vs. 5.7 [2.6]; P < 0.001) and visits (8.7 [1.7] vs. 6.5 [2.4]; P < 0.001) decreased for eyes completing 24 months of treatment. When data from 60 eligible eyes that did not complete 2 years follow-up, along with 14 eyes that switched to ranibizumab, were included using last observation carried forward, the mean change in visual acuity from baseline was +5.6 letters (95% confidence interval: 3.3-7.7).


CONCLUSIONS
These data indicate that eyes treated with aflibercept, as a sole therapy, in routine clinical practice with a T&E regimen can achieve good visual outcomes while decreasing the burden of treatments and clinic visits.
Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.|The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
Daniel
D
Barthelmes
The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
Vuong
V
Nguyen
The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.|Montpellier University Hospital, Montpellier, France.
Vincent
V
Daien
The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
Anna
A
Campain
The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
Richard
R
Walton
Department of Surgery (Ophthalmology), Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Victoria, Australia.
Robyn
R
Guymer
Department of Population Health, University of Western Australia, Perth, Western Australia.
Nigel
N
Morlet
The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.|Retina Associates, Chatswood, New South Wales, Australia.
Alex P
AP
Hunyor
Academic Unit of Ophthalmology, Australian National University, Acton, Australian Capital Territory, Australia.
Rohan W
RW
Essex
Marsden Eye Specialists, Parramatta, New South Wales, Australia.
Jennifer J
JJ
Arnold
The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
Mark C
MC
Gillies
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D011446:Prospective Studies; D040262:Receptors, Vascular Endothelial Growth Factor / Q000008:administration & dosage* / Q000037:antagonists & inhibitors; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage*; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology
D011993:Recombinant Fusion Proteins; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor