Preferred treatment regimen of aflibercept after treatment interruption in patients with neovascular age-related macular degeneration

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BACKGROUND: The efficacy of antiangiogenic therapy in neovascular age-related macular degeneration depends on adherence to the intravitreal injection regimen and regular follow-up. In 2020, the COVID-19 pandemic and associated epidemiological restrictions in ophthalmological care delivery led to a massive lack of appropriate control and management of this condition.

AIM: To determine the preferred regimen of intravitreal anti-VEGF therapy in patients with neovascular age-related macular degeneration who experienced treatment interruption due to the COVID-19 pandemic.

MATERIAL AND METHODS: Thirty eyes of 26 patients (20 males and 6 females, mean age 73.7±10.4 years) with neovascular age-related macular degeneration were included; all of them experienced treatment interruption due to the COVID-19 pandemic during the second year of aflibercept therapy. Re-starting therapy, all patients were divided in two groups and received treatment as per the fixed dosing (bimonthly), or as pro re nata (PRN) regimen. All patients underwent standard ophthalmological examination and optical coherence tomography before and after treatment interruption as well as six months after treatment re-start.

RESULTS: At six months after treatment re-start, best corrected visual acuity and central retinal thickness did not show statistically significant difference similar between the fixed dosing group and that of PRN dosing regimen (p=0.34 and p=0.85, respectively). However, patients of the fixed dosing group received for one more injection than those of the PRN group (median value – 2.0 injections, 95% confidence interval – 2.0-2.4; p=0.0001). Preservation of the disease activity according to optical coherence tomography data, in the fixed regimen group was found in 10 eyes (71.4 %) versus 9 eyes (56.2 %) in the PRN group (p=0.63).

CONCLUSIONS: For neovascular age-related macular degeneration patients at the second year of treatment, an adequate therapeutic strategy for re-starting anti-VEGF therapy after treatment interruption appears to be the PRN regimen. PRN regimen allows reducing one injection in comparison to fixed dosing regimen with comparable functional outcomes during first 6 month.

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About the authors

Aleksandr S. Kharakozov

S.M.Kirov Military medical academy

ORCID iD: 0000-0003-4598-0826
SPIN-code: 1208-5237

assistant head of department, ophthalmologist
Russian Federation, 6G, Akademika Lebedeva street, Saint-Petersburg, 194044

Alexey N. Kulikov

S.M. Kirov Military Medical Academy

ORCID iD: 0000-0002-5274-6993
SPIN-code: 6440-7706
Scopus Author ID: 57001225300
ResearcherId: M-2094-2016

MD, PhD, DMedSc, Professor, Head of the Department, Ophthalmology Department

Russian Federation, 6G, Akademika Lebedeva street, Saint-Petersburg, 194044

Dmitrii S. Maltsev

S.M. Kirov Military Medical Academy

Author for correspondence.
ORCID iD: 0000-0001-6598-3982

MD, PhD, DMedSc, head of the department of laser surgery of the ophthalmology department

Russian Federation, 21/1, Botkinskaya str., Saint Petersburg, 194044


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Copyright (c) 2021 Kharakozov A.S., Kulikov A.N., Maltsev D.S.

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