Compliance and Visual Outcome Of “Treat-And-Extend” Versus “Pro Re Nata”Dosing of Intravitreal Bevacizumab in Wet Age-Related Macular Degeneration – A Perspective From a Developing Country

  • Kriti Joshi Lumbini Eye Institute and Research Center https://orcid.org/0000-0001-8998-9852
  • Anadi Khatri KC Birat Medical College and Teaching Hospital and Teaching Hospital
  • Roshija Khanal Rijal ASG Hospitals
  • Salma KC Rai Shree Krishna Netralaya
  • Gyanendra Lammichane Lumbini Eye Institute and research centre
  • Roshan Dev Yadav Lumbini Eye Institute and research centre
Keywords: ARMD, Nepal, cost-effectiveness, PRN,TREX

Abstract

Introduction: Age- related Macular Degeneration (AMD) is the commonest cause of irreversible blindness and visual impairment in elderly, aged50 years or older contributing 8.7% of global blindness. Among the two types: “dry” and “wet”, the “wet” variant is treated using anti-VEGFs, mainly via two regimen – PRN or TREX.

Objective: To study and compare the compliance, cost and visual outcome of “Treat-and- Extend (TREX)”versus “Pro Re Nata(PRN)” dosing of intravitrealbevacizumab in Wet AMD.

Methodology: Sixty-four eyes of 64 patients with treatment naïve neovascular AMD were included and randomly divided into two groups, with each group comprising 32 eyes, by lottery system: “Group A [TREX]” and “Group B [PRN]”. Group A was treated with intravitrealbevacizumab [1.25mg/0.05ml] at presentation and at 1-month interval for 3 consecutive months [loading dose] and monthly till dry macula was obtained. Group B was treated with the same in “as needed” basis.Both Groups were followed up, for 1 year.

Results
Mean gain in visual acuity in the PRN group was 0.09 +/- 0.35 log MAR unit and in TREX, it was 0.14 +/- 0.3 log MAR unit within the period of 1 year.64% of the patients were compliant in TREX and 36% moderately complaint whereas in the PRN group, 24% were compliant, 60% moderately compliant and 16% noncompliant. Average hospital cost in PRN and TREX was NRs. 16, 170 (USD 149) and 23,785(USD 220) respectively.

Conclusion: Compliance and visual outcome were better in TREX in comparison toPRN at 1 year of treatment with intravitrealbevacizumab for Wet AMD.

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Author Biographies

Kriti Joshi, Lumbini Eye Institute and Research Center

Ophthalmologist, Department of Ophthalmology

Anadi Khatri KC, Birat Medical College and Teaching Hospital and Teaching Hospital

Lecturer, Department of Ophthalmology

Roshija Khanal Rijal, ASG Hospitals

Vitreoretina Consultant, Department of Ophthalmology

Salma KC Rai, Shree Krishna Netralaya

Professor, Department of Ophthalmology

Gyanendra Lammichane, Lumbini Eye Institute and research centre

Associate Professor, Department of Ophthalmology

Roshan Dev Yadav, Lumbini Eye Institute and research centre

Consultant, Department of Ophthalmology

Published
2020-06-26
How to Cite
Joshi, K., KC, A., Rijal, R., Rai, S., Lammichane, G., & Yadav, R. (2020). Compliance and Visual Outcome Of “Treat-And-Extend” Versus “Pro Re Nata”Dosing of Intravitreal Bevacizumab in Wet Age-Related Macular Degeneration – A Perspective From a Developing Country. Birat Journal of Health Sciences, 5(1), 921-926. https://doi.org/10.3126/bjhs.v5i1.29614
Section
Original Research Articles