When treating wet AMD patients with anti-VEGF, researchers in Canada recently confirmed the long-held belief that the change in vision from baseline is no worse with a treat-and-extend regimen compared with a monthly regimen of ranibizumab through 24 months. As the treat-and-extend approach eliminates the need for frequent assessment-related visits, the researchers suggest it could be more convenient for both patients and clinics and may also result in better retention rates and visual outcomes.

Of the 466 participants who completed the study, those in the treat-and-extend arm received a mean of 17.6 injections compared with 23.5 injections for the monthly arm over two years. At 24 months, proportions of treat-and-extend patients experiencing visual gains of 10 letters or more were not worse than in the monthly arm (42.9% in the treat-and-extend vs. 36.4% in the monthly). That was also the case for gains of 15 letters or more—25.5% in the treat-and-extend group vs. 23.1% in the monthly group. In the treat-and-extend arm, 6.5% of patients lost 15 or more letters vs. 5.8% in the monthly group. 

In the treat-and-extend group, 73.7% of the patients were able to extend their treatment interval to eight or more weeks during the 24 months of treatment and 43.1% of patients reached the 12-week maximum extension interval.

The study concluded that fewer injections and visits have the potential to increase convenience and reduce the cost to the health care system while still achieving clinically meaningful improvements in best-corrected visual acuity.

Kertes PJ, Galic IJ, Greve M, et al. Efficacy of a treat-and-extend regimen with ranibizumab in patients with neovascular age-related macular disease: a randomized clinical trial. JAMA Ophthalmol. January 9, 2020. [Epub ahead of print].