SIRE: Short interval in real life Does intensive anti-VEGF treatment in the first year predict subsequent treatment burden in exudative age-related macular degeneration?

Abstract

Background: Anti-VEGF's have changed the prognosis of exudative age-related macular degeneration (AMD). Ranibizumab and aflibercept have proven their functional efficacy, but their use has revealed in real life a wide variety of patient profiles with varied responses to treatment. This work focused on patients receiving "intensive" IVT treatment with a sustained injection rhythm, also referred to as having a high treatment burden.

Objective: The main objective of this work was to determine, in real-life conditions, the proportion of patients receiving "intensive" treatment among those being followed for exudative AMD. Secondary objectives were to analyse the long-term functional outcomes of these patients, their anatomical characteristics, and the evolution of their treatment regimen.

Method: A retrospective descriptive single-centre real-life study was conducted on patients treated for exudative AMD with intensive treatment (intervals of less than 8 weeks during the first year of treatment). A subgroup analysis compared patients who exceeded Q8 during follow-up (Group 1) versus patients remaining in intensive treatment (Group 2).

Results: A total of 301 records were analysed, with 24.9% of the eyes (n = 75) considered under intensive treatment. The mean age was 84 years ( ± 7.5), and 61% were men. Type 1 choroidal neovascularization (CNV) accounted for 64% of our cohort, type 2 CNV represented 29.3%, and type 3 was involved in 6.7%. The mean follow-up was 5.6 years ( ± 3.6), with an average number of 41 IVT ( ± 26.7). Visual acuity was maintained at 0.53 ( ± 0.2) baseline vs. 0.61 ( ± 0.2) after 5 years of follow-up (p = 0.02). Central retinal thickness (CRT) and subretinal fluid (SRF) were significantly reduced during our follow-up, and PED height remained stable. Almost half of the eyes (44%) had an extension of their interval ( > Q8) beyond the first year; however, this objective was achieved on average after 4.5 years of treatment. The visual acuity of Group 2 ( < Q8), despite receiving more injections, was superior to that of Group 1 ( > Q8) with baseline values of 0.57 ( ± 0.2) and 0.48 ( ± 0.2) (p = 0.161) respectively, and at 5 years 0.79 ( ± 0.2) and 0.54 ( ± 0.2) (p = 0.026). Similarly, CRT, PED height, and SRF were higher in Group 2. The distribution of neovascular types showed more type 2 in Group 1 (45.5% vs. 16.7%).

Conclusion: Patients requiring intensive treatment represent about ¼ of our AMD patient population. Despite the high treatment burden, these patients maintain their visual acuity at 5 years. An extension of intervals is observed in nearly half of the patients, occurring late. Intensive treatment during the first year appears to be predictive of a future hight treatment burden.