Are Treat-and-Extend Protocols Effective in AMD?

Saranya C. Balasubramaniam, MD; Sophie J. Bakri, MD


February 02, 2015

Anti-VEGF Treatment in Neovascular Age-Related Macular Degeneration: A Treat-and-Extend Protocol Over 2 Years

Abedi F, Wickremasinghe S, Islam AF, Inglis KM, Guymer RH
Retina. 2014;34:1531-1538

Study Summary

In this prospective 2-year study, Abedi and colleagues assessed 120 treatment-naive patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration (AMD). Patients were administered a treat-and-extend protocol with either 0.5 mg ranibizumab or 1.25 mg bevacizumab. After patients received three initial monthly injections, optical coherence tomography and fundus examinations were performed, with the injection interval extended by 2 weeks (with a maximum interval of 12 weeks) if there were no signs of exudative activity. If recurrent choroidal neovascularization was noted, however, the interval was shortened by 2 weeks.

At 12 and 24 months, visual acuity improved by 9.5 ± 10.9 ETDRS letters and 8.0 ± 12.9 ETDRS letters, respectively. The mean number of injections also decreased from the first to the second study year. Visual outcome data were comparable with those reported in the pivotal ANCHOR and MARINA studies.


This is the first study to report prospective data at 2 years with a treat-and-extend protocol in a relatively large cohort of patients. This protocol resulted in similar visual outcomes to the MARINA and ANCHOR studies, but achieved fewer injections and clinic visits at both 12 months and 24 months. The treat-and-extend protocol in patients with exudative AMD allows for an individualized treatment regimen with comparable visual outcomes to those seen in earlier pivotal studies.



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