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UK Neovascular Age-Related Macular Degeneration Database. Report 6: time to retreatment after a pause in therapy. Outcomes from 92 976 intravitreal ranibizumab injections
  1. Krishnappa C Madhusudhana1,
  2. Aaron Y Lee2,3,4,
  3. Pearse A Keane2,3,
  4. Usha Chakravarthy5,
  5. Robert L Johnston6,
  6. Catherine A Egan2,3,
  7. Dawn Sim2,3,
  8. Javier Zarranz-Ventura2,3,6,
  9. Adnan Tufail2,3,
  10. Martin McKibbin7
  11. On behalf of the UK AMD EMR Study Group
    1. 1Medical Retina Service, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
    2. 2NIHR Biomedical Research Centre at Moorfields Eye Hospital and the Institute of Ophthalmology, University College London, London, UK
    3. 3Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
    4. 4Department of Ophthalmology, University of Washington, Seattle, Washington, USA
    5. 5Centre for Vascular & Vision Sciences, Queen's University, Belfast, UK
    6. 6Medical Retina Service, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham General Hospital, Cheltenham, UK
    7. 7Eye Clinic, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
    1. Correspondence to Martin McKibbin, Eye Clinic, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK; Martin.McKibbin{at}


    Background/aims To study the time to retreatment in eyes with neovascular age-related macular degeneration (nAMD) that had been treatment-free for intervals of 3 months, 6 months, 9 months and 12 months during the maintenance phase of ranibizumab therapy within the UK National Health Service.

    Methods In this multicentre national nAMD database study, structured data were collected from 14 centres (involving 12 951 eyes receiving 92 976 ranibizumab injections). Patients were treated with three fixed, monthly injections in a loading phase of treatment, followed by a pro re nata retreatment regimen in a maintenance phase. Eyes with a treatment-free interval (TFI) of 3 months, 6 months, 9 months or 12 months in the maintenance phase were identified and the time to retreatment after these TFIs was determined.

    Results The time to retreatment for the 20th and 50th centiles was 0.58/2.54 months after a 3-month TFI, 2.07/9.62 months after a 6-month TFI, 3.69/15.84 months after a 9-month TFI and 5.90/22.49 months after a 12-month TFI. Following a TFI of 3 months, 6 months, 9 months and 12 months, 68%, 44%, 31% and 21% of eyes required retreatments after an additional 6 months of follow-up, respectively. Similarly, after 12 months of follow-up, 77%, 56%, 43% and 34% of these eyes required retreatment.

    Conclusions This study provides times to retreatment in eyes with nAMD that have been treatment-free for intervals of 3–12 months and demonstrates the likelihood of repeat therapy within the next year, even after a TFI of 12 months. These outcomes can help plan appropriate follow-up intervals for patients who have been treatment-free for intervals of up to 12 months.

    • Degeneration
    • Macula
    • Neovascularisation
    • Retina
    • Treatment Medical

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    • KCM and AYL are joint first authors.

    • Collaborators UK AMD EMR study group: Adnan Tufail, MD, FRCOphth; Robert Johnston, FRCOphth; Toks Akerele, MD, FRCOphth; Martin McKibbin, FRCOphth; Louise Downey, MBChB, FRCOphth; Salim Natha, MBChB, FRCOphth; Usha Chakravarthy, MD, PhD; Clare Bailey, MD, FRCOphth; Rehna Khan, MBChB; Richard Antcliff, FRCOphth; Stewart Armstrong, FRCOphth; Atul Varma, MSCOphth; Vineeth Kumar, FRCSEd(Ophth); Marie Tsaloumas, MBBS, FRCOphth; Kaveri Mandal, FRCSEd(Ophth); Wen Xing, MSc; and Catey Bunce, DSc.

    • Contributors All authors have given final approval of this version to be published. AT, MM, RLJ and UC participated in study codesigning, data collection and screening, data analysis and evidence synthesis, and revising the manuscript. KCM and AYL participated in literature search, data analysis and evidence synthesis, and drafting the manuscript. PAK, CAE, DS, JZ-V participated in study codesigning, data collection and revising the manuscript.

    • Funding Supported in part by an unrestricted grant from Novartis Pharmaceuticals UK Limited, Frimley, UK.

    • Competing interests MM reports grants from Alcon, personal fees and non-financial support from Novartis Pharmaceuticals, personal fees from Alimera Sciences, personal fees and non-financial support from Bayer Healthcare, outside the submitted work. PAK, AT and CAE have received a proportion of their funding from the Department of Health's NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology. PAK has given educational lectures for Topcon, Heidelberg, Novartis and Allergan. RLJ is the Medical Director and part owner of Medisoft Limited (the electronic medical record software provider from which data were extracted), Leeds, UK. He has also received research funding from Novartis, lecturing and advisory board funding from Alcon, Alimera Science, Bayer and Allergan. JZ-V is a grant recipient of the Spanish Retina & Vitreous Society (Sociedad Española de Retina y Vítreo). DS is a grant recipient of Fight for Sight UK. PAK, JZ-V and DS are members of the Allergan European Retina Panel.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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