Evolution of treatment paradigms in neovascular age-related macular degeneration: a review of real-world evidence

Br J Ophthalmol. 2021 Nov;105(11):1475-1479. doi: 10.1136/bjophthalmol-2020-317434. Epub 2020 Oct 31.

Abstract

The aim of this work was to evaluate the contribution of real-world evidence (RWE) in changing anti-vascular endothelial growth factor (VEGF) therapy treatment practices and improving real-world treatment strategies for neovascular age-related macular degeneration (nAMD).A PubMed literature search was performed to review the large number of English-language studies conducted to investigate the real-world effectiveness of anti-VEGF (aflibercept and ranibizumab) treatment paradigms available for nAMD.The evidence for pro re nata (PRN), treat-and-extend (T&E) and fixed bimonthly dosing regimens for anti-VEGF treatment of nAMD were reviewed and findings are summarised. RWE demonstrated that T&E regimens optimise visual outcomes while reducing burden on patients, clinics and physicians, compared with both fixed-dose and PRN regimens.RWE has helped to develop and improve real-world treatment strategies in nAMD, with the aim of optimising visual outcomes and reducing treatment burden in clinical practice. Of the various regimens, a T&E regimen is most likely to adequately balance clinical outcomes and treatment burden for patients with nAMD.

Keywords: Epidemiology; Macula; Neovascularisation; Retina; Vision.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Angiogenesis Inhibitors / therapeutic use*
  • Humans
  • Macular Degeneration / drug therapy
  • Macular Degeneration / therapy*
  • Ranibizumab / therapeutic use*
  • Recombinant Fusion Proteins / therapeutic use
  • Treatment Outcome
  • Vascular Endothelial Growth Factor A / drug effects
  • Visual Acuity
  • Wet Macular Degeneration / drug therapy*

Substances

  • Angiogenesis Inhibitors
  • Recombinant Fusion Proteins
  • Vascular Endothelial Growth Factor A
  • Ranibizumab