A new study has demonstrated that a particular biomarker can be used to select which age-related macular degeneration (AMD) patients can discontinue their anti-VEGF therapy.
South Korean researchers recently validated a treat-and-stop (TES) protocol through the identification of OCT-angiography (OCT-A) biomarkers that correspond with recurrent sustained exudation choroidal neovascularisation (CNV).
According to the team both treat-and-extend regimens and the TES protocol have shown comparable effectiveness compared to fixed dosing schedules, however the guidelines for discontinuing treatment are not yet clear.
In total 128 patients with neovascular AMD (nAMD) were enrolled in the study and split into ‘stop treatment’ and ‘continuing treatment’ groups.
The TES protocol was applied to patients who, after three initial monthly injections, were able to extend their treatment. This decision was based on whether their macula had no signs of fluid in an OCT scan and clinical examination.
As soon as the macula was free of fluid, the treatment intervals were successively increased by two weeks until three months had passed. Patients then received two or more injections at three-month intervals, and if the macula remained dry treatments were suspended.
If at any point a new CNV developed or recurrence of the previous CNV was found, treatment was immediately reinitiated.
The researchers concluded the appearance of neovascularisation may be used to determine the prognosis of anti-VEGF therapy response in nAMD patients. They also concluded that TES is reasonable making discontinuing treatment a possibility for some patients.
According to the authors there are no set guidelines for discontinuing treatment. Frequent anti-VEGF therapy can erode the quality of life for nAMD patients and their caregivers’, in addition to financial strain and loss of productivity.
“Our findings have two main consequences: first, confirming the validity of TES regimens and promoting the possibility of discontinuing treatment,” the study said.
“And second, verifying the morphologic pattern of CNV on OCT-A after anti-VEGF treatment as a useful biomarker determining whether to stop anti-VEGF injection or to continue disease suppression by maintenance therapy.”
