T&E Regimen, Consistent Adherence Important to Management of nAMD

Posters presented at the American Academy of Ophthalmology 2022 annual meeting showed that an 8-year treat-and-extend (T&E) regimen was effective in managing visual acuity (VA) in patients with neovascular age-related macular degeneration (nAMD), making consistent adherence to treatment for older patients with nAMD vital to optimizing outcomes.

T&E regimens are commonly used for intravitreal antivascular endothelial growth factor (VEGF) treatment in patients with nAMD.

The first poster¹ evaluated 8-year VA outcomes after T&E treatment. In this retrospective, interventional, single-center case center study, 165 treatment-naive eyes from 137 patients were evaluated. The eyes were treated with ranibizumab, aflibercept, bevacizumab, or brolucizumab for 1 or more years. The average best corrected visual acuity (BCVA) was 53 ETDRS letters.

The mean number of injections per patient from year 1 to year 8 were 7.9, 6.1, 5.8, 6.0, 6.2, 5.9, 6.2, and 6.0, respectively, with corresonding mean (SD) BCVA changes from baseline of 8.3 (21.8), 7.1 (25.0), 4.7 (26.5), 4.5 (27.1), 4.5 (28.3), 5.1 (26.5), –0.5 (34.8), and –4.3 (38.9) ETDRS letters. A total of 24.2% of the eyes lost at least 15 letters, 26.1% gained at least 15 letters, and 49.7% maintained vision within 15 letters by the final follow-up.

The researchers concluded that treatment with a T&E regimen was effective in maintaining VA in nAMD for 6 years of treatment. The seventh and eighth year saw a decline in ETDRS letters, but further data collection would be needed to confirm these findings.

The second poster² was focused on determining which patients with nAMD were most likely to be lost to follow-up, as consistent treatment is key to optimizing their outcomes and learning how to treat patients with nAMD.

The study used the IRIS Registry from the AAO to gather data on participants. Patients whose nAMD was diagnosed between January 1, 2013, and December 31, 2015, and treated with anti-VEGF therapy from January 1, 2013, to December 31, 2018, were included in the study. Patients with proliferative diabetic retinopathy, diabetic macular edema, retinal vein occlusion, myopic degeneration, and idiopathic choroidal neovascularization were excluded from this study.

Loss to follow-up was defined as patients not being seen for more than a year after their last intravitreal injection. A multivariable logistic regression analysis was used to determine the odds ratios (ORs) of each result.

A total of 191,694 patients were included in the analysis, 11% of whom were lost to follow-up. Age was a primary risk factor for loss to follow-up, as patients aged 76 to 80 years (OR, 1.20; 95% CI, 1.10-1.31), 81 to 85 years (OR, 1.48; 95% CI, 1.36-1.60), 86 to 90 years (OR, 2.05; 95% CI, 1.89-2.22), and older than 90 years (OR, 2.95; 95% CI, 2.72-3.19) were more likely to be lost to follow-up compared with patients younger than 70 years.

Women were found to be less likely to be lost to follow-up (OR, 0.82; 95% CI, 0.80-0.85) compared with men, and African American patients (OR, 1.28; 95% CI, 1.07-1.52) and Hispanic patients (OR, 1.20; 95% CI, 1.09-1.33) were more likely to be lost to follow-up compared with White patients.

Also more likely to be lost to follow-up were patients with unilateral disease (OR, 2.43; 95% CI, 2.30-2.57) vs those who were affected bilaterally and patients with Medicaid coverage (OR, 1.42; 95% CI, 1.17-1.74) vs private insurance. Patients with Medicare coverage were less likely to be lost to follow-up (OR, 0.73; 95% CI, 0.69-0.78) vs those with private insurance.

The researchers concluded there was a high rate of loss to follow-up in patients with nAMD who were treated with anti-VEGF injections, with the biggest risk factors of losing a patient to follow-up included age, male sex, African American and Hispanic ethnicity, unilateral disease, and Medicaid insurance. New strategies, they concluded, are needed to encourage better compliance and adherence to maximize outcomes in patients with nAMD.

These 2 posters combine to present a view of nAMD that encourages treatment and narrows down those who are most at risk for stopping treatment that would help their visual outcomes. Learning which treatments are the most effective in maintaining VA could help encourage those who are less likely to maintain treatment to stay on their treatment.

References

1. Fong RD, Thomas M, Romero C, et al. Eight-year VA outcomes of the T&E regimen in the management of nAMD. Presented at: AAO 2022; September 30, 2022-October 3, 2022; Chicago, IL. Abstract PO419.

2. Khurana RN, Li C, Lum F. Loss to follow-up in patients with nAMD treated with anti-VEGF therapy in the U.S. Presented at: AAO 2022; September 30, 2022-October 3, 2022; Chicago, IL. Abstract PO377.