Treatment intervals with first-generation anti-vascular endothelial growth factor drugs: evaluating the unmet need in a real-world neovascular age-related macular degeneration national database.

BACKGROUND

To evaluate treatment intervals at 12/24 months following initiation of anti-VEGF therapy and to characterise the clinical profile of neovascular AMD (nAMD) patients achieving extended treatment intervals (≥12 and ≥16 weeks).

METHODS

National, retrospective, real-world study using data from the validated web-based Fight Retinal Blindness (FRB!) registry. Treatment-naive nAMD eyes managed with approved first-generation intravitreal VEGF inhibitors (ranibizumab, aflibercept 2 mg) and followed for at least 12 months were included. A subanalysis was conducted on eyes receiving a number of injections within range of a treat and extend (TAE) regimen at 12 and 24 months.

RESULTS

A total number of 1278/557 treatment-naïve nAMD eyes within the TAE range category completed the required follow up at 12/24 months. At 12 months, 39.3% of eyes remained on ≤Q8W, 22.5% >Q8W- < Q12W, 29.1% ≥Q12W- < Q16 and 9.1% ≥Q16W. At 24 months, the distribution was 35.4%, 17.6%, 28.3% and 18.7%, respectively. Mean VA change was not significantly different between groups at both 12 months (≤ Q8W: +4.7, Q8-Q12: +3.5, Q12-Q16: +6.1, ≥Q16W: +4.8 letters) and 24 months (≤Q8W: +5.8, Q8-Q12: +3.7, Q12-Q16: +4.1, ≥Q16W: +3 letters). The percentage of visits with active lesions was similar across groups at both time points, indicating consistent disease control.

CONCLUSIONS

Despite receiving a number of injections within a TAE range, a substantial proportion of eyes failed to achieve extended treatment intervals at 12 and 24 months (61.8% and 52.9%, respectively). These results underscore the significant unmet therapeutic need in the management of nAMD with currently approved first-generation anti-VEGF agents.