Good Early Response Key to Anti-VEGF Treatment Cessation

Patients who respond well early in the course of management with anti-vascular endothelial growth factor (VEGF) intravitreal injections have the potential to cease treatment altogether, according to a report from Clinical Ophthalmology. The patients in the study had exudative age-related macular degeneration (AMD) and pachychoroid neovasculopathy (PN) and were managed using a  treat-and-extend (TAE) approach.

“This information could help physicians predict the achievement of treatment cessation for a considerable period,” according to the researchers.

The retrospective study looked at 101 treatment-naïve eyes of 101 patients with exudative AMD and PN. Patients had anti-VEGF therapy using TAE and treatment cessation regimen with a follow-up period of at least 12 months. Researchers measured best-corrected visual acuity (BCVA), treatment frequency, and number of eyes with successful treatment cessation were measured. They defined successful treatment cessation as dry macula retention without treatment for >16 weeks following the last injections. They evaluated factors related to the successful treatment cessation. 

They found that BCVA was maintained at the last visit, with a mean follow-up period of 49.9±26.9 months. From the first year to the fifth year, the injection number decreased from 6.8±2.31 to 3.7±3.64, respectively. By the last visit a total of 48 (47.5%) eyes were being treated at an interval of ≥12 weeks or were under treatment cessation.

“Successful treatment cessation during the follow-up period and at the last visit were achieved in 56 (55.4%) and 27 (26.7%) eyes, with a median treatment-free period of 66 and 126 weeks, respectively. Good early treatment response and a small recurrence number were associated with successful treatment cessation at the last visit,” the study says.

The study did have limitations, including its design, its relatively small patient population size, the use of 2 different anti-VEGF agents, maximum treatment intervals, treatment regimens, and different follow-up periods. 

A number of patients also underwent additional photodynamic therapy and cataract surgery. Finally, because the study was conducted in a common clinical practice, genetic background was not investigated.

Reference

Kinoshita T, Mori J, Hatanaka A, Shimizu M, Imaizumi H. Visual outcome and treatment frequency of anti-vegf therapy using the treat-and-extend and treatment cessation regimen for exudative age-related macular degeneration and pachychoroid neovasculopathy. Clin Ophthalmol. 2021;15(11):4405-4418. doi:10.2147/OPTH.S334641