INTRODUCTION: Treatment of exudative age-related macular degeneration (ARMD) has shifted to pro re nata and treat-extend-stop strategies. However, a rational discontinuation strategy is lacking. To develop such a strategy, it is important to determine choroidal neovascularization (CNV) recurrence rates after anti-VEGF treatment is discontinued.
METHODS: This prospective, single-centre clinical trial enrolled 191 patients with exudative ARMD. Patients were randomly assigned to receive intravitreal bevacizumab injections every 4, 6, or 8 weeks for one year. CNV activity was determined in the 157 patients who completed the one-year treatment regimen. Patients with inactive CNV were then followed for signs of CNV reactivation.
RESULTS: After one year of treatment, 66 (42%) of the 157 patients still had signs of persistent active CNV. Of the remaining 91 (58%) patients, 61 (67%) needed retreatment for active CNV within the first year after discontinuation of treatment (mean 4.28±0.29 months). CNV was reactivated in 50 (80%) of the 61 patients within 6 months after their final treatment for CNV.
CONCLUSION: Based on quiescent disease, anti-VEGF therapy was discontinued in 58% of patients after they received bevacizumab injections every 4, 6, or 8 weeks for one year; 67% showed reactivated CNV within the year after discontinuation. The high reactivation rate of CNV shown in this study, should help clinicians develop rational discontinuation protocols.
|Publication status||E-pub ahead of print - 19 Jan 2021|