Efficacy, safety, and treatment burden of treat-and-extend versus alternative anti-VEGF regimens for nAMD: a systematic review and meta-analysis

This study aimed to compare efficacy and treatment burden of treat-and-extend (T&E) anti-VEGF against fixed and pro re nata (PRN) regimens for neovascular age-related macular degeneration (nAMD). MEDLINE, CENTRAL, and EMBASE were searched. Randomized-controlled trials and observational studies c...

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Published in:Eye (London) 2023-01, Vol.37 (1), p.6-16
Main Authors: Rosenberg, Daniel, Deonarain, Deven M., Gould, Jonah, Sothivannan, Amirthan, Phillips, Mark R., Sarohia, Gurkaran S., Sivaprasad, Sobha, Wykoff, Charles C., Cheung, Chui Ming Gemmy, Sarraf, David, Bakri, Sophie J., Chaudhary, Varun
Format: Article
Language:English
Subjects:
692/699/3161/1626
692/699/3161/3175
Acuity
Age
Angiogenesis Inhibitors - therapeutic use
Citations
Clinical Protocols
Clinical trials
Consultants
Dosage
Drug dosages
Humans
Intravitreal Injections
Laboratory Medicine
Macular degeneration
Medicine
Medicine & Public Health
Meta-analysis
Observational studies
Ophthalmology
Patients
Pharmaceutical Sciences/Technology
Randomized Controlled Trials as Topic
Ranibizumab
Receptors, Vascular Endothelial Growth Factor
Recombinant Fusion Proteins - therapeutic use
Remission (Medicine)
Review
Review Article
Surgery
Surgical Oncology
Systematic review
Treatment Outcome
Vascular endothelial growth factor
Vascular Endothelial Growth Factor A
Visual acuity
Wet Macular Degeneration - drug therapy
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Summary:This study aimed to compare efficacy and treatment burden of treat-and-extend (T&E) anti-VEGF against fixed and pro re nata (PRN) regimens for neovascular age-related macular degeneration (nAMD). MEDLINE, CENTRAL, and EMBASE were searched. Randomized-controlled trials and observational studies comparing T&E to PRN or fixed dosing for treatment-naïve AMD patients were included. Mean difference (MD) for visual acuity (VA) and number of injections are presented. Risk of bias was assessed according to Cochrane guidelines. Methodology was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). VA improvement was similar with T&E and fixed dosing at one (MD −0.08 letters, p  = 0.95) and two years (MD 0.58 letters, p  = 0.62). In contrast, VA improvements were significantly greater for T&E when compared against a PRN regimen at one (MD 3.95 letters, p  
ISSN:0950-222X
1476-5454
1476-5454
DOI:10.1038/s41433-022-02020-7