While patients may prefer the convenience of as-needed injections of ranibizumab for neovascular age-related macular degeneration (AMD), a new suggests clinicians should stick with a scheduled treatment regimen.

Researchers recently conducted a systematic review and meta-analysis to better understand the impact of various treatment protocols on visual outcomes for patients with neovascular AMD. They found four eligible, each of which used ranibizumab (a total of 940 eyes); two randomized controlled trials compared treat-and-extend (T&E) to monthly protocols and two retrospective reviews compared treat-and-extend to PRN therapy.

While visual and central retinal thickness improvements were similar between T&E and monthly at 12 months, the small mean difference of -1.79 letters and 3.76μm favored monthly injections. Still, the T&E group showed higher visual gains compared with the PRN group.

In terms of convenience, those using the T&E protocol required fewer injections compared with monthly, although T&E required a mean of 1.44 more injections than PRN at 12 months; yet the researchers noted this was achieved with fewer visits.

“Despite the growing preference for the T&E regimen, there is limited head-to-head evidence comparing dosing strategies. The evidence available, however, suggests that at 12 months, T&E is comparable to monthly and superior to PRN dosing for both efficacy and safety outcomes when using ranibizumab,” the study concluded.

Okada M, Kandasamy R, Chong EW, et al. The treat-and-extend injection regimen versus alternate dosing strategies in age-related macular degeneration: a systematic review and meta-analysis. Am J Ophthalmol. June 6, 2018. [Epub ahead of print].