Treat and Extend versus Pro Re Nata regimens of ranibizumab in neovascular age‐related macular degeneration: a comparative 12 Month study

Purpose To compare outcomes in patients with treatment‐naïve neovascular age‐related macular degeneration ( nAMD ) receiving ranibizumab treat and extend ( TE ) with those receiving ranibizumab pro re nata ( PRN ) in a clinical setting. Methods During this 12‐month retrospective, consecutive, comparative case series, patients received ranibizumab 0.5 mg according to a TE or PRN regimen. Monthly optical coherence tomography ( OCT ) evaluation was performed during the PRN regimen; retreatment criteria included recurrence of intra‐/subretinal fluid, or haemorrhages. During the TE regimen, initial treatment with 4‐week intervals was sequentially lengthened by 2 weeks until signs of choroidal neovascularization ( CNV ) activity recurred. Study end‐points included mean change in best corrected visual acuity ( BCVA ) and central retinal thickness ( CRT ), mean injection frequency and number of follow‐up visits attended. Results Baseline characteristics were similar between the TE ( n  = 70) and PRN ( n  = 70) groups. Mean change in BCVA from baseline to Month 12 was significantly greater in the TE group than the PRN group (+0.18 ± 0.17 versus +0.07 ± 0.20, p < 0.001). Mean change in CRT from baseline to Month 12 was greater in the TE group than the PRN group (−116 ± 132 versus −58 ± 157  μ m, p = 0.019). The number of follow‐up visits attended was significantly higher in the PRN group than the TE group (11.9 ± 1.1 versus 8.6 ± 1.9, p < 0.001), while patients in the TE group received more injections during the study than those in the PRN group (8.6 ± 1.9 versus 6.0 ± 1.9, p < 0.001). Conclusion Ranibizumab administered using a TE regimen in treatment‐naïve patients with nAMD provided better visual outcomes with fewer clinic visits, compared with a PRN regimen.