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A systematic review to assess the “Treat-and-Extend” dosing regimen for neovascular age-related macular degeneration using ranibizumab

A systematic review to assess the “Treat-and-Extend” dosing regimen for neovascular age-related macular degeneration using ranibizumab
A systematic review to assess the “Treat-and-Extend” dosing regimen for neovascular age-related macular degeneration using ranibizumab
Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in the developed world. Monthly or as-needed (PRN) dosing strategies of intravitreal ranibizumab have been established as efficacious treatment options for neovascular AMD. More recently, the ‘treat-and-extend’ dosing regimen (TREX) is being adopted in clinical practice as it represents a patient-centric and economical option, reducing treatment burden by extending injection intervals when possible. However, the efficacy of TREX using ranibizumab monotherapy remains to be defined. Therefore, we performed a systematic review to assess the current evidence for TREX using ranibizumab by searching MEDLINE, Embase and PubMed. Of the 1733 articles identified, nine TREX studies were included in our analysis (n=748 eyes). Average patient age was 79.25 (range: 77.34–82.00; SD: 7.27). Baseline BCVA ranged from 48.5–68.9 ETDRS letters. BCVA improvement was 8.92 letters at 1 year (range: 6.5–11.5; SD: 7.54), as a weighted mean accounting for numbers of study eyes. The weighted mean number of injections at one year was 8.60 (range: 7.3–12.0; SD: 1.73). Previously, the landmark ANCHOR and MARINA trials reported gains of 11.3 and 7.2 letters, respectively, using monthly ranibizumab. Chin-Yee et al reported a gain of 3.5 ETDRS letters with 5.3 (S.D. 0.66) PRN ranibizumab injections as weighted means at 1 year in their recent systematic review. Our analysis suggests that TREX delivers visual outcomes superior to PRN and approaches similar efficacy to monthly injections. Further RCTs are needed to fully evaluate the efficacy and economy of TREX in the long-term.
0950-222X
1337-1344
Rufai, S.R.
33ada28b-2d6c-479f-a012-6956f7e7ccbe
Almuhtaseb, H.
27fcdbb3-4784-483d-823c-c6dae6151578
Paul, Richard
6426de18-df3a-4fe8-8844-828ed35978a2
Stuart, B.L.
626862fc-892b-4f6d-9cbb-7a8d7172b209
Kendrick, T.
c697a72c-c698-469d-8ac2-f00df40583e5
Lee, H.
5d36fd1e-9334-4db5-b201-034d147133fb
Lotery, A.J.
5ecc2d2d-d0b4-468f-ad2c-df7156f8e514
Rufai, S.R.
33ada28b-2d6c-479f-a012-6956f7e7ccbe
Almuhtaseb, H.
27fcdbb3-4784-483d-823c-c6dae6151578
Paul, Richard
6426de18-df3a-4fe8-8844-828ed35978a2
Stuart, B.L.
626862fc-892b-4f6d-9cbb-7a8d7172b209
Kendrick, T.
c697a72c-c698-469d-8ac2-f00df40583e5
Lee, H.
5d36fd1e-9334-4db5-b201-034d147133fb
Lotery, A.J.
5ecc2d2d-d0b4-468f-ad2c-df7156f8e514

Rufai, S.R., Almuhtaseb, H., Paul, Richard, Stuart, B.L., Kendrick, T., Lee, H. and Lotery, A.J. (2017) A systematic review to assess the “Treat-and-Extend” dosing regimen for neovascular age-related macular degeneration using ranibizumab. Eye, 31, 1337-1344. (doi:10.1038/eye.2017.67).

Record type: Article

Abstract

Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in the developed world. Monthly or as-needed (PRN) dosing strategies of intravitreal ranibizumab have been established as efficacious treatment options for neovascular AMD. More recently, the ‘treat-and-extend’ dosing regimen (TREX) is being adopted in clinical practice as it represents a patient-centric and economical option, reducing treatment burden by extending injection intervals when possible. However, the efficacy of TREX using ranibizumab monotherapy remains to be defined. Therefore, we performed a systematic review to assess the current evidence for TREX using ranibizumab by searching MEDLINE, Embase and PubMed. Of the 1733 articles identified, nine TREX studies were included in our analysis (n=748 eyes). Average patient age was 79.25 (range: 77.34–82.00; SD: 7.27). Baseline BCVA ranged from 48.5–68.9 ETDRS letters. BCVA improvement was 8.92 letters at 1 year (range: 6.5–11.5; SD: 7.54), as a weighted mean accounting for numbers of study eyes. The weighted mean number of injections at one year was 8.60 (range: 7.3–12.0; SD: 1.73). Previously, the landmark ANCHOR and MARINA trials reported gains of 11.3 and 7.2 letters, respectively, using monthly ranibizumab. Chin-Yee et al reported a gain of 3.5 ETDRS letters with 5.3 (S.D. 0.66) PRN ranibizumab injections as weighted means at 1 year in their recent systematic review. Our analysis suggests that TREX delivers visual outcomes superior to PRN and approaches similar efficacy to monthly injections. Further RCTs are needed to fully evaluate the efficacy and economy of TREX in the long-term.

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Accepted Manuscript: TREX Systematic Review - Accepted Manuscript
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Accepted/In Press date: 13 March 2017
e-pub ahead of print date: 5 May 2017
Published date: September 2017
Organisations: Primary Care & Population Sciences, Clinical & Experimental Sciences

Identifiers

Local EPrints ID: 406746
URI: https://eprints.soton.ac.uk/id/eprint/406746
ISSN: 0950-222X
PURE UUID: 136dd40e-3abe-46f7-8d77-e1fce33d1302
ORCID for Richard Paul: ORCID iD orcid.org/0000-0002-3480-5232
ORCID for T. Kendrick: ORCID iD orcid.org/0000-0003-1618-9381
ORCID for H. Lee: ORCID iD orcid.org/0000-0002-2573-9536
ORCID for A.J. Lotery: ORCID iD orcid.org/0000-0001-5541-4305

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Date deposited: 22 Mar 2017 02:05
Last modified: 03 Dec 2019 06:13

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Contributors

Author: S.R. Rufai
Author: H. Almuhtaseb
Author: Richard Paul ORCID iD
Author: B.L. Stuart
Author: T. Kendrick ORCID iD
Author: H. Lee ORCID iD
Author: A.J. Lotery ORCID iD

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