Treatment Regimens with Ranibizumab in Neovascular Age-Related Macular Degeneration: Real-World Results from the PACIFIC Study Author List

Katrin Lorenz,1 Christos Haritoglou,2 Daniel Barthelmes,3 Armin Mir Mohi Sefat,4 Hüsnü Berk,5 Erik Beeke,6 Martin Scheffler,7 Matthias Iwersen,8 Bettina Müller,8 Focke Ziemssen9,10 On behalf of members of the PACIFIC study group1Augenklinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Germany; 2Herzog Carl Theodor Eye Hospital, Munich, Germany; 3Augenklinik, Universitäts Spital Zürich, Zurich, Switzerland; 4Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Luebeck, Luebeck, Germany; 5Klinik für Augenheilkunde, St. Elisabeth-Krankenhaus GmbH, Cologne, Germany; 6Augenzentrum Osnabrueck, Osnabrueck, Germany; 7Augenheilkunde Rhauderfehn, Rhauderfehn, Germany; 8Novartis Pharma GmbH, Nuremberg, Germany; 9Klinik und Poliklinik fuer Augenheilkunde, Universitätsklinikum Leipzig, Leipzig, Germany; 10Department Fuer Augenheilkunde, Eberhard-Karls-Universität Tuebingen, Tuebingen, GermanyCorrespondence: Katrin Lorenz, Augenklinik und Poliklinik, Universitätsmedizin Mainz, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany, Email [email protected]: Intravitreal anti-VEGF is the gold standard for treating neovascular age-related macular degeneration (nAMD). The treatment success depends not only on drug efficacy but also on regimen feasibility for physicians and patients. The implementation of different regimen might lead to varying outcomes. “Treat-and-extend” aims to minimize undertreatment with injections at each visit and tailored intervals. This study investigates the utilization and effectiveness of ranibizumab in nAMD, focusing on different treatment regimens in real-world settings.Materials and Methods: The PACIFIC study, a non-interventional, prospective, multicenter study, included nAMD patients treated with ranibizumab at 185 sites across Germany, the Netherlands and Switzerland. Over 24 months, functional and morphological outcomes were documented for 3051 patients over 24 months, highlighting the practiced treatment regimens.Results: A pattern of an observational approach with nevertheless increasing interval extension prevailed (70.4%, 1028 pre-treated; 68.6%, 1090 treatment-naïve patients), emerging as the preferred strategy within the first 3 months. Across all regimens, the average number of injections was comparable (mean ± SD: 7.34 ±  5.30 in pre-treated; 7.26 ±  4.70 in treatment-naïve patients). The treat and extend regimen, however, demonstrated superior effectiveness in improving visual acuity, particularly among treatment-naïve patients (number of injections: 7.89 ±  5.54 pre-treated; 9.54 ±  5.42 treatment-naïve patients).Conclusion: Over 2-year observational period, the treat and extend regimen emerged as a highly effective approach, particularly for those newly diagnosed, with a low risk of undertreatment. Despite its benefits, an unconscious shift to a observe-and-extend or “monitor-and-extend” approach occurred early in treatment, highlighting the need for tailored approaches to optimize patient outcomes in clinical practice.Keywords: anti-VEGF, visual acuity, treatment regimen, functional outcome, real-world result