Injection burden and treatment intervals of aflibercept in observe‐and‐plan regimen for neovascular age‐related macular degeneration

• Published in: Acta ophthalmologica (Oxford, England) England), 2024-11, Vol.102 (7), p.821-827
• Main Authors: Subhi, Yousif, Schneider, Miklos, Hajari, Javad Nouri, Cour, Morten
• Format: Article
• Language: English
• Subjects: aflibercept; Aged; Aged, 80 and over; Angiogenesis Inhibitors - administration & dosage; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug therapy; Female; Fluorescein Angiography - methods; Follow-Up Studies; Fundus Oculi; Humans; Intravitreal Injections; Macula Lutea - diagnostic imaging; Macula Lutea - pathology; Macular degeneration; Male; neovascular age‐related macular degeneration; observe‐and‐plan; real‐world data; Receptors, Vascular Endothelial Growth Factor - administration & dosage; Receptors, Vascular Endothelial Growth Factor - therapeutic use; Recombinant Fusion Proteins - administration & dosage; Registries; Retrospective Studies; Time Factors; Tomography, Optical Coherence - methods; Treatment Outcome; treatment regimen; Vascular Endothelial Growth Factor A - antagonists & inhibitors; Visual Acuity; Wet Macular Degeneration - diagnosis; Wet Macular Degeneration - drug therapy
• ISSN: 1755-375X; 1755-3768; 1755-3768
• DOI: 10.1111/aos.16709

Purpose The Observe‐and‐Plan (O&P) regimen allows for individualised treatment. In this study, we evaluated injection burden and intervals using aflibercept in an O&P regimen for eyes with neovascular age‐related macular degeneration (AMD). Methods This was a retrospective registry‐based study of treatment‐naïve eyes with neovascular AMD. Treatment data were compiled for 3 years after commencement of intravitreal aflibercept therapy. We evaluated clinical consequences at the first follow‐up after loading dose, the proportion of patients who obtained and kept dry macula after loading dose, number of injections and intervals between injections. Results Data were obtained for 1103 eyes. After loading dose, 0.4% were lost to follow‐up, 7.5% discontinued, 50.9% booked for further injections and 41.3% booked for monthly observations. After loading dose, the macula remained dry in 49.2% at 3 months, 34.0% at 6 months, 23.7% at 12 months and 15.2% at 24 months. For the entire population, median cumulative total number of injections was 7, 12 and 15, after 1, 2 and 3 years, respectively. After the 3rd year, the proportion of eyes in the short 4–6 weeks treatment interval was 51.1%, 8 weeks interval was kept in 14.4% and the extended treatment intervals of 10 and 12 weeks was possible in 34.4%. Conclusion After loading dose, one in two eyes required further injections. A large proportion required therapy with shorter intervals than the label‐recommended 8 weeks. The large majority of those who obtained a dry macula after loading dose turned exudative again, mostly within the first 3 months.