{"title":"From pro-re-nata to fixed-interval regimen: evolving real-world treatment paradigms in anti-VEGF therapy for neovascular AMD.","authors":"Daniele Veritti, Valentina Sarao, Paolo Lanzetta","doi":"10.1038/s41433-025-03627-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of evolving treatment paradigms for neovascular age-related macular degeneration (nAMD) by comparing outcomes between two patient cohorts treated with different anti-vascular endothelial growth factor (anti-VEGF) regimens over a decade apart.</p><p><strong>Methods: </strong>This retrospective cohort study included 200 treatment-naive nAMD patients divided into two cohorts. Cohort 1 (2009-2010) was treated with a pro re nata (PRN) regimen, involving three initial monthly injections followed by as-needed treatments based on monthly monitoring. Cohort 2 (2019-2021) received a fixed-interval regimen, consisting of three initial monthly injections followed by bimonthly maintenance doses. Primary outcomes included changes in best corrected visual acuity (BCVA) and central retinal thickness (CRT) at 12 months. Secondary outcomes included the number of injections, follow-up visits, and adherence to treatment schedules.</p><p><strong>Results: </strong>Cohort 2 demonstrated significantly greater improvement in BCVA (+5.5 vs -2.0 ETDRS letters, p < 0.001) and CRT reduction (-101.7 vs -26.5 μm, p < 0.001) compared to Cohort 1. Patients in Cohort 2 received more injections (7.7 vs 4.8, p < 0.001) but required fewer monitoring visits (3.2 vs 5.1, p < 0.001). Adherence to treatment schedules was markedly higher in Cohort 2 (78% vs 0%, p < 0.001).</p><p><strong>Conclusions: </strong>The transition from a PRN to a fixed-interval anti-VEGF regimen significantly improved visual and anatomical outcomes in nAMD patients. Fixed-interval regimens not only enhanced treatment efficacy but also optimized resource utilization, suggesting a superior approach for managing nAMD in a real-world clinical setting.</p>","PeriodicalId":12125,"journal":{"name":"Eye","volume":" ","pages":"1349-1355"},"PeriodicalIF":2.8000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043998/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Eye","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1038/s41433-025-03627-2","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/29 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: To evaluate the impact of evolving treatment paradigms for neovascular age-related macular degeneration (nAMD) by comparing outcomes between two patient cohorts treated with different anti-vascular endothelial growth factor (anti-VEGF) regimens over a decade apart.
Methods: This retrospective cohort study included 200 treatment-naive nAMD patients divided into two cohorts. Cohort 1 (2009-2010) was treated with a pro re nata (PRN) regimen, involving three initial monthly injections followed by as-needed treatments based on monthly monitoring. Cohort 2 (2019-2021) received a fixed-interval regimen, consisting of three initial monthly injections followed by bimonthly maintenance doses. Primary outcomes included changes in best corrected visual acuity (BCVA) and central retinal thickness (CRT) at 12 months. Secondary outcomes included the number of injections, follow-up visits, and adherence to treatment schedules.
Results: Cohort 2 demonstrated significantly greater improvement in BCVA (+5.5 vs -2.0 ETDRS letters, p < 0.001) and CRT reduction (-101.7 vs -26.5 μm, p < 0.001) compared to Cohort 1. Patients in Cohort 2 received more injections (7.7 vs 4.8, p < 0.001) but required fewer monitoring visits (3.2 vs 5.1, p < 0.001). Adherence to treatment schedules was markedly higher in Cohort 2 (78% vs 0%, p < 0.001).
Conclusions: The transition from a PRN to a fixed-interval anti-VEGF regimen significantly improved visual and anatomical outcomes in nAMD patients. Fixed-interval regimens not only enhanced treatment efficacy but also optimized resource utilization, suggesting a superior approach for managing nAMD in a real-world clinical setting.
目的：通过比较使用不同抗血管内皮生长因子（anti-VEGF）治疗方案的两组患者的预后，评估不断发展的治疗模式对新生血管性年龄相关性黄斑变性（nAMD）的影响。方法：回顾性队列研究纳入200例未接受治疗的nAMD患者，分为两组。队列1（2009-2010）采用自然（PRN）方案治疗，包括最初每月注射三次，然后根据每月监测按需治疗。队列2（2019-2021）接受固定间隔方案，包括初始每月注射三次，然后每两个月注射一次维持剂量。主要结果包括12个月时最佳矫正视力（BCVA）和中央视网膜厚度（CRT）的变化。次要结果包括注射次数、随访次数和对治疗计划的依从性。结果：队列2显示BCVA的改善明显更大（+5.5 vs -2.0 ETDRS字母，p）。结论：从PRN到固定间隔抗vegf方案的过渡显著改善了nAMD患者的视觉和解剖结果。固定间隔方案不仅提高了治疗效果，而且优化了资源利用，表明在现实世界的临床环境中管理nAMD的优越方法。
期刊介绍：
Eye seeks to provide the international practising ophthalmologist with high quality articles, of academic rigour, on the latest global clinical and laboratory based research. Its core aim is to advance the science and practice of ophthalmology with the latest clinical- and scientific-based research. Whilst principally aimed at the practising clinician, the journal contains material of interest to a wider readership including optometrists, orthoptists, other health care professionals and research workers in all aspects of the field of visual science worldwide. Eye is the official journal of The Royal College of Ophthalmologists.
Eye encourages the submission of original articles covering all aspects of ophthalmology including: external eye disease; oculo-plastic surgery; orbital and lacrimal disease; ocular surface and corneal disorders; paediatric ophthalmology and strabismus; glaucoma; medical and surgical retina; neuro-ophthalmology; cataract and refractive surgery; ocular oncology; ophthalmic pathology; ophthalmic genetics.
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