Treat-and-Extend Regimens for the Management of Neovascular Age-related Macular Degeneration and Polypoidal Choroidal Vasculopathy: Consensus and Recommendations From the Asia-Pacific Vitreo-retina Society.

Purpose: Review and provide consensus recommendations on use of treat-and-extend (T&E) regimens for neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV) management with relevance for clinicians in the Asia-Pacific region.
Methods: A systematic search of MEDLINE, EMBASE, and Cochrane databases, and abstract databases of the Asia-Pacific Vitreo-retina Society, European Society of Retina Specialists, American Academy of Ophthalmology, and Controversies in Ophthalmology: Asia-Australia congresses, was conducted to assess evidence for T&E regimens in nAMD. Only studies with ≥100 study eyes were included. An expert panel reviewed the results and key factors potentially influencing the use of T&E regimens in nAMD and PCV, and subsequently formed consensus recommendations for their application in the Asia-Pacific region.
Results: Twenty-seven studies were included. Studies demonstrated that T&E regimens with aflibercept, ranibizumab, or bevacizumab in nAMD, and with aflibercept in PCV, were efficacious and safe. The recommendation for T&E is, after ≥3 consecutive monthly loading doses, treatment intervals can be extended by 2 to 4 weeks up to 12 to 16 weeks. When disease activity recurs, the recommendation is to reinject and shorten intervals by 2 to 4 weeks until fluid resolution, after which treatment intervals can again be extended. Intraretinal fluid should be treated until resolved; however, persistent minimal subretinal fluid after consecutive treatments may be tolerated with treatment intervals maintained or extended if the clinical condition is stable.
Conclusions: T&E regimens are efficacious and safe for nAMD and PCV, can reduce the number of visits, and minimize the overall burden for clinicians and patients.
Competing Interests: Conflicts of interest: VC: honoraria from Bayer, Novartis, Roche for lecture fees and research grants from Bayer, Roche; MS: honoraria from Allergan, Bayer, Novartis, Roche for lecture fees, consultancy and board membership, research grants from Allergan, Bayer, Novartis; TL: honoraria from Allergan, Bayer, Boehringer Ingelheim, Novartis, Roche for consultancy, research grants from Novartis and Roche; GT: honoraria from Allergan, Bayer, Roche, Novartis, Topcon, and research grant from Leica and Santen; NF: honoraria from Bayer, Novartis, and Allergan for lecture fees; MO: honoraria from Bayer, Novartis, Santen, Kowa, Otsuka for lecture fees, research grants from Alcon, Bayer, Hoya, Novartis, Otsuka, Santen, Senju, and consultancy fees from Allergan, Bayer, Chengdu Kanghong Biotechnology, Chugai, Novartis; PM: N/A;
(Copyright © 2021 Asia-Pacific Academy of Ophthalmology. Published by Wolters Kluwer Health, Inc. on behalf of the Asia-Pacific Academy of Ophthalmology.)