Researchers from South Korea have validated the TES protocol through the identification of OCT-A biomarkers that correspond with recurrent sustained exudation choroidal neovascularization (CNV).
In age-related macular degeneration (AMD), treat-and-extend regimens, along with the treat-extend-stop (TES) protocol, have shown comparable efficacy to fixed dosing.
Now, researchers from South Korea have validated the TES protocol through the identification of OCT-A biomarkers that correspond with recurrent sustained exudation choroidal neovascularization (CNV). These findings confirm that discontinuing treatment is possible in certain patients with neovascular AMD if CNV is not observed on OCT-A after anti-VEGF treatment, said Kunho Bae, MD, et al.1
Study design and results
A total of 128 patients (134 eyes) with neovascular AMD were enrolled and split into two groups: stop treatment (n = 44) and continuing treatment (n = 90).
To be enrolled in the stop treatment group, patients must have met the TES criteria for treatment cessation. In this study, the TES protocol encompassed the following: after 3 injections at 4-week intervals, the treatment period was extended if the macula was determined to be without fluid on OCT and clinical examination.
As soon as the macula was free of fluid, the treatment intervals were increased successively by 2 weeks until 12 weeks had passed. Patients then received 2 or more injections at 12-week intervals, and if the macula remained dry, treatments were suspended and the patients were monitored carefully.
Mean age across the study was 73.8 years (range, 54-92), and the majority of patients were male (62%). Additional baseline clinical characteristics are outlined in the Table.
Bae K, Kim HJ, Shin YK, Kang SW. Predictors of neovascular activity during neovascular age-related macular degeneration treatment based on optical coherence tomography angiography. Scientific reports 2019;9:19240.
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3. Prenner JL, Halperin LS, Rycroft C, Hogue S, Williams Liu Z, Seibert R. Disease Burden in the Treatment of Age-Related Macular Degeneration: Findings From a Time-and-Motion Study. Am J Ophthalmol 2015;160:725-31.e1.
4. Arnold JJ, Campain A, Barthelmes D, et al. Two-year outcomes of "treat and extend" intravitreal therapy for neovascular age-related macular degeneration. Ophthalmology 2015;122:1212-9.
5. Adrean SD, Chaili S, Ramkumar H, Pirouz A, Grant S. Consistent Long-Term Therapy of Neovascular Age-Related Macular Degeneration Managed by 50 or More Anti-VEGF Injections Using a Treat-Extend-Stop Protocol. Ophthalmology 2018;125:1047-1053.