The FUSION Regimen for Exudative AMD

6,883 views

Published on

A proposed new regimen of anti VEGF ranibizumab therapy for exudative Age-Related Macular Degeneration to achieve same benefit than monthly injections with less injections and also avoiding the limitations of the on-demand regimens

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
6,883
On SlideShare
0
From Embeds
0
Number of Embeds
5,577
Actions
Shares
0
Downloads
0
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

The FUSION Regimen for Exudative AMD

  1. 1. jmones@institutmacularetina.com<br />Therationaleforthe FUSION Regimen<br />Jordi Monés<br />Institutde la Màcula i de la Retina<br />Centro Médico Teknon, Barcelona<br />
  2. 2. jmones@institutmacularetina.com<br />Monthlyregimen: Marina Anchor<br />
  3. 3. jmones@institutmacularetina.com<br />Quarterlyregimen: PIER<br />
  4. 4. jmones@institutmacularetina.com<br />Monthy vs quarterly: EXCITE<br />
  5. 5. jmones@institutmacularetina.com<br />Ondemand (PRN): SUSTAIN<br />
  6. 6. jmones@institutmacularetina.com<br />Mean VA ARMS of mainTrials<br />
  7. 7. jmones@institutmacularetina.com<br />PRN seemstoworkfor CNV 2ry tomyopia<br />MonésJ, Amselem L , Serrano A , García M , Hijano M. Intravitrealranibizumab for choroidalneovascularization secondary to pathologic myopia: 12-month results. Eye. 2009 Jun;23(6):1275-80<br />
  8. 8. jmones@institutmacularetina.com<br />PRN inferior tomonthly in AMD<br />BiarnésM, Monés J, Villalbí JR, Arias L. [Epub ahead of print] As-needed treatment with ranibizumab 0.5 mg in patients with neovascular age-related macular degeneration.Eur J Ophthalmol. 2010 Sep 29. <br />
  9. 9. jmones@institutmacularetina.com<br />“THE” slide: Dynamics of lost and recovery of VA afterrelapse<br />
  10. 10. …so, which is likely to be the key??<br />MONTLY treatmentANTICIPATESdiseaseactivity, treatment has theinitiative<br />PRN treatment, bydefinition, LAG BEHIND diseaseactivity, thedisease has theinitiative<br />
  11. 11. Then..which would be the IDEAL treatment?<br />TryingtoANTICIPATEtheactivityprogressionBUT WITHOUT monthlyinjections<br />FUSION Regimenproposal:<br />PRNRegimen + FIXEDinjectionsaftercertain time of inactivity<br />
  12. 12. FUSION Regimen<br />(Ophthalmolgica, Epub ahead):<br />Loadingphase<br />( 2 or 3 )<br />+<br />PRN treatment<br />( follow-up /4-6w)<br />+<br />Fixedmaintenanceinjections<br />Aftercertain time of inactivity<br />
  13. 13. Regimen FUSION ( J Monés, Ophthalmolgica, Epub ahead):<br />
  14. 14. <ul><li>Retrospectivestudy of17 “NAIVE” eyes of 17 patients(14/17 women, 82%)
  15. 15. Median age 77 years (66 a 85), 17/17 caucasians; 7/17 OD (41.2%)
  16. 16. Median basal BCVA 67letters (Snellen20/50++), rangefrom 45 (20/125) to 85 (20/20)
  17. 17. “Subgroups” BCVA basal <20/40: 58 (20/63--, median), </li></ul> BCVA basal>=20/40: 81.5 (20/25++, median)<br />
  18. 18. <ul><li> Median time of follow-up: 6 months(rangefrom 4 to 12m)
  19. 19. Final median BCVA 73 (20/32--), rangefrom 49 (20/100-) to 85 (20/20)
  20. 20. Mean change of +6 letters(p<0.05) </li></li></ul><li><ul><li>6/17 (35.3%) neededthe 3 loading IVI
  21. 21. in themaintenancephase, retreatmentwasperformed in 33/65 (50.8%) as maintenance(no exudation). In theresttherewassomeextent of exudation
  22. 22. Adverse events: 1 RPE tear (1/17, 5.9%)</li></li></ul><li>
  23. 23. <ul><li> % of stabilization: Losslessthan 1 line: 13/17 (76.5%)</li></li></ul><li><ul><li> % of stabilization: Losslessthan 1 line by “subgroups” (p>0.05):</li></ul>BCVA basal <20/40 (6/8, 75%)<br />BCVA basal >=20/40 (7/9, 77.8%)<br />
  24. 24. <ul><li> % of patientsavoidingmoderate visual loss ( 15 letters): 17/17 (100%)
  25. 25. % of significantimprovement of VA (>=15 letters): 2/17 (11.8%)
  26. 26. % of significantimprovement (>=15 letters) in basal BCVA <20/40: 2/11 (18.2%)</li></li></ul><li>baseline<br />1m<br />7m<br />5m<br />2m<br />20/40<br />20/50<br />20/50<br />20/80<br />
  27. 27. 10m<br />13m<br />16m<br />20m<br />24m<br />20/40<br />20/40<br />20/40<br />20/50<br />
  28. 28. <ul><li>thisregimentreatmentbetteranticipatestherelapse of activity, and mayavoidtheloss of thevisiongainedin theloadingphase
  29. 29. Ifconfirmed in a largerscale trial, FUSIONregimenmaybeanalternative t tothemonthlyinjectionregimenbutmaintainingitsadvantages, differentlyfromthe PRN regimens
  30. 30. treating (apparently) inactive eyesdemandsmuch more understandingfrompatients, and more difficulttohandlepotentialcomplications. However, byfaritiswithinthenumber of injections of thebestcurrentstandard of care, monthlyinjections</li>

×