A study conducted at Kyung Hee University Medical Center has provided insights on the risks and recurrence rates of neovascular age-related macular degeneration (nAMD) following the discontinuation of anti-vascular endothelial growth factor (VEGF) therapy based on a modified treat-and-extend (TAE) regimen. This research is particularly relevant as AMD continues to be a leading cause of severe visual impairment among older adults.
The investigation involved 68 patients who underwent analysis to determine the effectiveness and safety of this modified protocol. Therapy was ceased after extending treatment intervals to at least five months and maintaining disease stability for six months. The goal was to ascertain how effective treatment discontinuation could be, along with the factors influencing the potential recurrence of nAMD.
The results revealed significant findings: recurrence rates after discontinuation stood at 22.2% at the one-year mark, 42.2% after two years, and increased to 54.4% over three years of follow-up. The median time to recurrence was marked at 16 months, with patients receiving an average of 7.7 injections before therapy cessation. These findings are pivotal as they provide clinicians with important metrics for evaluating when treatment might be safely stopped.
Among the group studied, it was noted with concern the prevalence of intraretinal cysts, which were significantly higher among those who experienced recurrence. The study highlighted, 22Rapid early response to treatment was associated with a lower risk of exudative recurrence.22 Such findings bolster the importance of patient monitoring during the early phases of treatment.
Age is another factor of interest, as the cohort had a mean age of 71.2 years, with 60.3% of participants being male. The mean follow-up duration leading up to the cessation of treatment averaged around 17.7 months. These demographics were important to understand the real-world applicability of the modified TAE approach.
Examining the baseline characteristics across those with and without recurrence revealed intriguing patterns. The presence of baseline intraretinal cysts appeared more common among those who faced recurrence as well as differences noted between rapid responders to treatment, evidenced by the significant disparity (71.0% vs. 37.8%) between the groups.
Despite recurrence, vision was maintained for up to two years after patients resumed treatment. Notably, among those who did experience vision loss of two or more lines, all five had evident subretinal hemorrhages during their baseline assessments. This correlation is particularly significant as it points to the potential need for heightened vigilance among patients presenting with similar conditions when treatment is paused.
The investigation notes how previous regimens could result in overtreatment due to the absence of standardized guidelines for maximum treatment intervals or criteria for stopping therapy altogether. This study's approach, which entails suspending treatment only after achieving stability for defined periods, appears to provide both effective outcomes and alleviate the patient burden from unnecessary injections.
The findings suggest the modified TAE protocol can successfully incorporate treatment pause without unduly compromising patient vision. Recommendations for future clinical protocols include closely monitoring patients with characteristic indicators such as intraretinal cysts post-treatment to prevent adverse outcomes.
It is clear from this research the complex dynamics involved when administering long-term therapies like anti-VEGF for conditions such as nAMD. Although over half of the participants faced reactivation within three years, overall visual acuity remained stable, emphasizing the necessity for personalized treatment strategies positioning the patient at the forefront.
To summarize, the study presents compelling evidence about managing nAMD through the modified TAE protocol. While it addresses the risk of recurrence, it also outlines important factors which may help predict which patients would respond favorably to discontinuation, assisting doctors to tailor treatments more adequately to individual needs. Future research should focus on optimizing these protocols, potentially leading to even greater advancements for patient care within ophthalmology.