Abstract / Synopsis:
Amid a treatment burden of regular injections, retina specialists have oved to treat-and-extend regimens, the effectiveness of which is supported by the literature.
Special to Ophthalmology Times
Anti-vascular endothelial growth factor (VEGF) injections are widely used in the United States for the treatment of neovascular (wet) age-related macular degeneration (AMD).
Given the treatment burden of injecting these drugs on a monthly or every-other-month schedule as initially recommended, the vast majority of U.S. retina specialists have moved to treat-and-extend regimens, the effectiveness of which is supported by the literature.1,2
In an ideal world, that would likely mean anti-VEGF injections would be given every month for a few months after the initiation of therapy, followed by longer durations, for a total of six to eight injections in the first year and fewer injections in subsequent years.
Related: Quest for data increases debate for anti-VEGF therapy approach
In clinical practice, several factors may prevent strict adherence to the intended schedule, including the basic biology of the disease in individual patients, physician factors (training, office scheduling), patient factors (concomitant health issues, difficulty with travel or family support, etc.) and health system factors (insurance constraints).
With the widespread adoption of the American Academy of Ophthalmologys IRIS Registry (Intelligent Research in Sight), it is now possible to analyze the real-world injection intervals of patients in the United States with wet AMD who are treated with anti-VEGF agents.
Since its launch in 2014, the IRIS Registry has rapidly become an extremely comprehensive data resource, with 274 million patient visits representing 63 million patients and more than 15,000 ophthalmologists.
Related:IRIS Registry study: Overall anti-VEGF injection intervals for wet AMD similar at 1, 2 years of treatment
In fact, there is so much data in the IRIS Registry that it requires sophisticated data science to analyze it effectively.
Verana Healththe data curation and analytics partner for the IRIS Registrywas founded by ophthalmic industry leaders to help physicians improve patient care through the power of big data.
The company is helping the academy and researchers like me derive new insights and accelerate clinical research.
1. Rufai SR, Almuhtaseb H, Paul RM, et al. A systematic review to assess the treat-and-extend dosing regimen for neovascular age-related macular degeneration using ranibizumab. Eye. 2017;31:1337-1344.
2. Vardarinos A, Gupta N, Janjua R, et al. 24-month clinical outcomes of a treat-and-extend regimen with ranibizumab for wet age-related macular degeneration in a real-life setting. BMC Ophthalmol. 2017;17:58.
3. MacCumber M, Yu, JS, Sagkriotis A, et al. Injection intervals in treatment-nave neovascular AMD patients who received anti-VEGF agents: An analysis of the IRIS Registry. American Academy of Ophthalmology, San Francisco, 2019:PO471.
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