Age-related macular degeneration (AMD) is a leading cause of blindness in people over 50. Neovascular AMD, the most serious and severe form, is characterized by the appearance, spread and growth of subretinal new vessels. One of the major molecular mediators is vascular endothelial growth factor (VEGF). Intra-vitreous (IVI) injection of an anti-VEGF can slow the progression of neovascular AMD and stabilize vision in the majority of cases. Aflibercept (Eylea®) is one of the anti-VEGF molecules approved in Belgium to treat neovascular AMD. At the start of its use, aflibercept was first injected monthly and then according to the PRN "reactive" protocol (Pro Renata). Over time, a new treatment strategy has emerged: the "treat-and-extend" (T\&E). This is individualized patient care, the objective of which is to reduce the frequency of injections while ensuring inactivity of the disease. This begins with the loading dose, i.e. 3 injections given 4 weeks apart. Thereafter, the interval is lengthened in increments of 1 or 2 weeks provided that the visual and anatomical results remain stable. In the event of deterioration, the interval is shortened while keeping a minimum of 4 weeks between each IVI. The efficacy and safety of aflibercept, when used in a proactive T\&E regimen, was demonstrated in the randomized controlled trial, ALTAIR. However, data on T\&E used in practice is still lacking. routine, and particularly the number of injections and treatment intervals over a minimum 24 month treatment period. The aim of this retrospective study carried out at the CHU Brugmann is to determine the number of injections and the intervals necessary to have encouraging results in terms of visual acuity, over a treatment period of at least one year.
Study Type
OBSERVATIONAL
Enrollment
36
Data extraction from medical files
CHU Brugmann
Brussels, Belgium
Injections number (first 24 months of treatment)
Number of injections during the first 24 months of treatment
Time frame: first 24 months of treatment
Injections interval
Last injection interval during the 2nd year of treatment, in weeks
Time frame: during the 2nd year of treatment
Injection number (up to 4 years of treatment)
Number of injections during the 1st, 2nd, 3rd and 4th year of treatment
Time frame: up to 4 years of treatment
Injections interval (up to 4 years of treatment)
Last injection interval during the 1st, 2nd, 3rd and 4th year of treatment (if applicable), in weeks
Time frame: up to 4 years of treatment
Most stable injection interval
Most stable injection interval during the 2nd, 3rd and 4th year of treatment (if applicable), in weeks
Time frame: up to 4 years of treatment
Overall extension interval
Expected overall extension interval: by 1 week, 2 weeks, 3 weeks or 4 weeks
Time frame: up to 4 years of treatment
Covid 19 impact
Covid19 impact on the injection interval (visits cancelled due to lock-down, shortening/increase of the injection interval due to hospital internal emergency procedures)
Time frame: up to 4 years of treatment
Number of follow-up visits
Number of follow-up visits during each year of treatment up to 4 years
Time frame: up to 4 years of treatment
Visual acuity
Visual acuity at baseline, after 90 days and at the end of each year of treatment up to 4 years
Time frame: up to 4 years of treatment
Age
Age of the patient at baseline
Time frame: Baseline
Eye lesion type
Eye lesion type
Time frame: Baseline
Fluid
Presence or absence of intra-retinal fluid, subretinal fluid, detachment of the pigment epithelium at baseline, after 90 days and at the end of each year of treatment up to 4 years
Time frame: up to 4 years of treatment
Date of first symptoms
Date of first symptoms of neovascular AMD
Time frame: Baseline
Date of first injection
Date of first ranibizumab injection
Time frame: Baseline
Retinal thickness
Retinal thickness at baseline, after 90 days and at the end of each year of treatment up to 4 years
Time frame: up to 4 years of treatment
Treatment regimen
Has there been a change in treatment regimen after the first 12 months of treatment?
Time frame: first 12 months of treatment
Number of patients stopping treatment (12-24 months)
Number of patients stopping treatment between 12 and 24 months of treatment
Time frame: between 12 and 24 months of treatment
Reason for stopping treatment (12-24 months)
Reason for stopping treatment between 12 and 24 months of treatment
Time frame: between 12 and 24 months of treatment
Number of patients stopping treatment (24-36 months)
Number of patients stopping treatment between 24 and 36 months of treatment
Time frame: between 24 and 36 months of treatment
Reason for stopping treatment (24-36 months)
Reason for stopping treatment between 24 and 36 months of treatment
Time frame: between 24 and 36 months of treatment
Number of patients stopping treatment (36-48 months)
Number of patients stopping treatment between 36 and 48 months of treatment
Time frame: between 36 and 48 months of treatment
Reason for stopping treatment (36-48 months)
Reason for stopping treatment between 36 and 48 months of treatment
Time frame: between 36 and 48 months of treatment
Number of patients stopping treatment (first 12 months)
Number of patients who stopped treatment in the first 12 months
Time frame: first 12 months of treatment
Reason for stopping treatment (first 12 months)
Reason for stopping treatment in the first 12 months
Time frame: first 12 months of treatment
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.