Prospective Trial of Treat-and-Extend versus Monthly Dosing for Neovascular Age-Related Macular Degeneration: TREX-AMD 1-Year Results
Charles C Wykoff, Daniel E Croft, David M Brown, Rui Wang, John F Payne, Lloyd Clark, Nizar Saleh Abdelfattah, SriniVas R Sadda, TREX-AMD Study Group, Charles C Wykoff, Daniel E Croft, David M Brown, Rui Wang, John F Payne, Lloyd Clark, Nizar Saleh Abdelfattah, SriniVas R Sadda, Matthew S Benz, Eric Chen, Richard H Fish, David L Johnson, Rosa Y Kim, James C Major Jr, Ronan E O'Malley, Amy C Schefler, Ankoor R Shah, Sushma K Vance, John A Wells 3rd, Tien P Wong, Charles C Wykoff, Daniel E Croft, David M Brown, Rui Wang, John F Payne, Lloyd Clark, Nizar Saleh Abdelfattah, SriniVas R Sadda, TREX-AMD Study Group, Charles C Wykoff, Daniel E Croft, David M Brown, Rui Wang, John F Payne, Lloyd Clark, Nizar Saleh Abdelfattah, SriniVas R Sadda, Matthew S Benz, Eric Chen, Richard H Fish, David L Johnson, Rosa Y Kim, James C Major Jr, Ronan E O'Malley, Amy C Schefler, Ankoor R Shah, Sushma K Vance, John A Wells 3rd, Tien P Wong
Abstract
Purpose: To assess prospectively a treat-and-extend (TREX) management strategy compared with monthly dosing of intravitreal ranibizumab in treatment-naïve neovascular age-related macular degeneration (AMD) patients.
Design: Phase IIIb, multicenter, randomized, controlled clinical trial.
Participants: Sixty patients with treatment-naïve neovascular AMD randomized 1:2 to monthly or TREX management.
Methods: Patients with Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) from 20/32 to 20/500 (Snellen equivalent) were randomized to receive intravitreal 0.5 mg ranibizumab monthly or according to a TREX protocol. The TREX patients were treated monthly for at least 3 doses, until resolution of clinical and spectral-domain optical coherence tomography evidence of exudative disease activity; the interval between visits then was individualized according to a strict prospective protocol.
Main outcome measures: Mean ETDRS BCVA change from baseline.
Results: At baseline, mean age was 77 years (range, 59-96 years), mean BCVA was 20/60 (Snellen equivalent), and mean central retinal thickness (CRT) was 511 μm. Fifty-seven eyes (95%) completed month 12, at which point mean BCVA improved by 9.2 and 10.5 letters in the monthly and TREX cohorts, respectively (P = 0.60). The mean number of injections administered through month 12 was 13.0 and 10.1 (range, 7-13) in the monthly and TREX cohorts, respectively (P < 0.0001). Among TREX patients, 7 (18%) were maximally extended, 4 (10%) demonstrated fluid at every visit, and at month 12, 18 (45%) had achieved an extension interval of 8 weeks or more; the mean maximum extension interval between injections after the first 3 monthly doses was 8.4 weeks (range, 4-12 weeks). Most TREX patients who demonstrated recurrent exudative disease activity (17/24 [71%]) were unable to extend beyond their initial maximum extension interval.
Conclusions: The TREX neovascular AMD management strategy used in this prospective, randomized, controlled trial resulted in visual and anatomic gains comparable with those obtained with monthly dosing.
Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Source: PubMed