Study Shows Long-Term Gains from Treat-and-Extend Therapy with Eylea in Wet Age-Related Macular Degeneration

MAY 04, 2016
Ellen Kurek
Several retrospective and prospective studies support the use of a treat-and-extend regimen of intravitreal injections of anti-VEGF (vascular endothelial growth factor) agents in patients with neovascular (wet) age-related macular degeneration (NVAMD). Such a regimen can reduce office visit and treatment burdens while achieving reasonable functional and anatomical results.
Most of these studies have focused on off-label bevacizumab (Avastin, Genentech/Roche) and ranibizumab (Lucentis, Genentech). However, use of a treat-and-extend regimen with the anti-VEGF agent aflibercept (Eylea, Regeneron), approved for NVAMD more recently than Lucentis, has not been validated (Avastin is not approved by the FDA for treating AMD). Thus, the durability of Eylea’s effect when used in this fashion is unclear.
“Each of these anti-VEGF molecules is different,” noted Francis DeCroos, MD, of the Wills Eye Institute in Philadelphia, PA. “Whether this makes a clinical difference is a matter of ongoing and lively debate.”
To determine visual and anatomic outcomes and the number of injections needed with a treat-and-extend Eylea regimen for NVAMD, DeCroos and colleagues completed the Aflibercept Treatment with Less-frequent Administration Study (ATLAS). This 2-year, multicenter, prospective, open-label study evaluated the use of this strategy in a single, treatment-naïve, NVAMD-affected eye of 40 patients.
DeCroos reported the 2-year results of ATLAS at the Association for Research in Vision and Ophthalmology (ARVO) Annual Meeting in Seattle, WA, on May 4, 2016. The results were also published in an abstract included in the ARVO proceedings.
To be eligible for study, eyes had to have macular fluid seen on spectral domain optical coherence tomography (OCT) and active leakage as confirmed by fluorescein angiography (FA) at baseline. Eyes were treated every 4 weeks until extension criteria (eg, no signs of macular exudation, such as fluid, hemorrhage, or leakage) were met.

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