As needed ranibizumab effective for exudative AMD

By Ingrid Grasmo

Study findings suggest that ranibizumab significantly improves visual acuity (VA) in patients with exudative age-related macular degeneration (AMD) when administered initially on a monthly basis and followed by re-treatment if needed.

This regimen of ranibizumab administration could help avoid the high costs and possible overtreatment of some patients associated with a fixed monthly regimen of 12 injections per year, say the researchers.

"The present study offers insight into treatment outcomes with ranibizumab using a disease activity-guided algorithm that encompasses a more complete assessment of disease," Sebastian Wolf (University Bern, Switzerland) and colleagues comment.

For the study, the researchers assessed disease activity in 316 patients with exudative AMD who were treated with three monthly injections of ranibizumab 0.5 mg, followed by monthly monitoring and at least quarterly injections. If patients showed signs of disease activity, a series of three consecutive monthly injections were administered after which patients returned to quarterly treatments if lesions were inactive.

Patients received an average of 18.9 injections over the 3-year period, with more injections administered during the first year compared with the second and third years (7.1 vs 5.0 and 5.2 injections, respectively).

The average best-corrected VA improved significantly from 52 letters at baseline to 58 letters at month 3. This was maintained through a 6-12 month period (59 letters) and improved further at 2 years (61 letters).

Furthermore, the proportion of patients with a VA of 60 letters or more increased significantly at 12, 24, and 36 months relative to baseline (52%, 57%, and 57% vs 41%, respectively).

The researchers also found that approximately one-quarter of patients showed a visual gain of 15 letters or more over the 3-year period. Conversely, a visual loss of 15 letters or more was observed in 4-7% of patients.

Writing in Acta Ophthalmologica, the team concludes: "With treatment decisions being made on a quarterly basis, the active disease-driven retreatment regimen described here may ensure comprehensive assessment of the disease and provide critical balance between efficacy and treatment burden."

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