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The Treat-and-Extend Injection Regimen Versus Alternate Dosing Strategies in Age-related Macular Degeneration: A Systematic Review and Meta-analysis

Journal

AMERICAN JOURNAL OF OPHTHALMOLOGY
Volume 192, Issue -, Pages 184-197

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1016/j.ajo.2018.05.026

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Funding

  1. NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL OF AUSTRALIA FELLOWSHIP [GNT1103013]

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PURPOSE: To assess outcomes of the treat-and-extend (T&E) injection regimen for neovascular age-related macular degeneration (AMD) as compared to either a monthly or a pro re nata (PRN) treatment strategy. DESIGN: Systematic review and meta-analysis. METHODS: Studies that compared the T&E regimen with either monthly or PRN dosing for treatment-naive AMD were included. Trial eligibility, data extraction, and risk of bias were assessed according to Cochrane review methods. Estimates were pooled using random effects meta-analysis. RESULTS: Four eligible studies were identified, all using ranibizumab (total N = 940 eyes), including 2 randomized controlled trials comparing T&E to monthly and 2 retrospective reviews comparing T&E to PRN. No studies evaluating aflibercept were identified. Improvements in vision and central retinal thickness were similar between T&E and monthly at 12 months, with a mean difference of -1.79 letters (95% confidence interval [CI]: 3.70, 0.13) and 3.76 mu m (95% CI:-13.78, 21.30) in favor of monthly injections. In contrast, visual gains were higher in the T&E compared to the PRN group (difference of +6.18 letters, 95% CI: 3.28, 9.08). Fewer injections were required using the T&E regimen when compared to monthly (mean of -1.6 and -6.9 injections at 12 and 24 months, respectively). A mean of 1.44 more injections was required for the T&E compared to PRN regimen at 12 months; however, this was achieved with fewer visits. CONCLUSION: Despite the growing preference for the T&E regimen, there is limited head-to-head evidence comparing dosing strategies. The evidence available, however, suggests that at 12 months, T&E is comparable to monthly and superior to PRN dosing for both efficacy and safety outcomes when using ranibizumab. (C) 2018 Elsevier Inc. All rights reserved.

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