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Retina. 2015 Aug;35(8):1489-506. doi: 10.1097/IAE.0000000000000627.

TREAT-AND-EXTEND REGIMENS WITH ANTI-VEGF AGENTS IN RETINAL DISEASES: A Literature Review and Consensus Recommendations.

Author information

1
*Vitreous Retina Macula Consultants of New York and Department of Ophthalmology, New York University Langone Medical Center, New York, New York; †Ophthalmology Service, CHU de Bordeaux, Bordeaux, France and INSERM, ISPED, Centre INSERM U897-Epidemiology-Biostatistics, Bordeaux, France; ‡The Donald K. Johnson Eye Center, The University Health Network, Toronto; The University of Toronto, Toronto, Canada; §University Eye Hospital Hannover, Hannover, Germany; ¶Montreal Retina Institute, Montreal, Canada; **Musgrove Park Hospital, Taunton, United Kingdom; ††Eye Clinic, Medical University, Göttingen, Germany; ‡‡Department of Medical and Biological Sciences, Ophthalmology, University of Udine, IEMO-Istituto Europeo di Microchirurgia Oculare, Udine, Italy; §§Department of Ophthalmology, City Hospital Triemli, Zurich; University of Zurich, Zurich, Switzerland; ¶¶Centre for Vision Research, Westmead Millennium Institute, University of Sydney, New South Wales, Australia; ***Macula and Retina Institute, Hospital Quiron Teknon, Barcelona; Barcelona Macula Foundation: Research for Vision, Barcelona, Spain; †††Retina Service and Mid Atlantic Retina, Wills Eye Hospital, Philadelphia, Pennsylvania; ‡‡‡Department of Ophthalmology, Hôpital Lariboisière, AP-HP, Université Paris 7 Sorbonne Paris Cité, Paris, France; §§§Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, United Kingdom; and ¶¶¶Department of Ophthalmology, Inselspital, University Hospital, University of Bern, Bern, Switzerland.

Abstract

PURPOSE:

A review of treat-and-extend regimens (TERs) with intravitreal anti-vascular endothelial growth factor agents in retinal diseases.

METHODS:

There is a lack of consensus on the definition and optimal application of TER in clinical practice. This article describes the supporting evidence and subsequent development of a generic algorithm for TER dosing with anti-vascular endothelial growth factor agents, considering factors such as criteria for extension.

RESULTS:

A TER algorithm was developed; TER is defined as an individualized proactive dosing regimen usually initiated by monthly injections until a maximal clinical response is observed (frequently determined by optical coherence tomography), followed by increasing intervals between injections (and evaluations) depending on disease activity. The TER regimen has emerged as an effective approach to tailoring the dosing regimen and for reducing treatment burden (visits and injections) compared with fixed monthly dosing or monthly visits with optical coherence tomography-guided regimens (as-needed or pro re nata). It is also considered a suitable approach in many retinal diseases managed with intravitreal anti-vascular endothelial growth factor therapy, given that all eyes differ in the need for repeat injections.

CONCLUSION:

It is hoped that this practical review and TER algorithm will be of benefit to health care professionals interested in the management of retinal diseases.

PMID:
26076215
DOI:
10.1097/IAE.0000000000000627
[Indexed for MEDLINE]
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