Evidence map›Paper›PMID 31900438›Full record

ArticleEye (London, England)2020

Recommendations by a UK expert panel on an aflibercept treat-and-extend pathway for the treatment of neovascular age-related macular degeneration.

Adam H Ross, Louise Downey, Helen Devonport, Richard P Gale, Ajay Kotagiri, Sajjad Mahmood, Hemal Mehta, Niro Narendran, Praveen J Patel, Nina Parmar and 1 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Eye (London, England), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
41citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

41 citing papers in PubMed, 5 syntheses or guidelines pooled it.

  1. Efficacy and Safety of Intravitreal Faricimab in Neovascular Age-Related Macular Degeneration, Diabetic Macular Edema, and Retinal Vein Occlusion: A Meta-Analysis.Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde · 2024
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  6. Switching to faricimab in anti-VEGF-refractory retinal vein occlusion: nine-month prospective real-world outcomes under a modified treat-and-extend regimen.Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Adam H RossUniversity Hospitals Bristol NHS Foundation Trust, Bristol, UK. adamross@doctors.org.uk.
Louise DowneyHull University Teaching Hospitals NHS Trust, Hull, UK.
Helen DevonportBradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.
Richard P GaleYork Teaching Hospital NHS Foundation Trust, York, UK.
Ajay KotagiriSouth Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK.
Sajjad MahmoodManchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
Hemal MehtaRoyal Free London NHS Foundation Trust, London, UK.
Niro NarendranThe Royal Wolverhampton NHS Trust, Wolverhampton, UK.
Praveen J PatelNIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
Nina ParmarBayer plc, Reading, UK.
Nitin JainBayer plc, Reading, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesThis report aims to provide clear recommendations and practical guidance from a panel of UK retinal experts on an aflibercept treat-and-extend (T&E) pathway that can be implemented in clinical practice. These recommendations may help service providers across the NHS intending to implement a T&E approach, with the aim of effectively addressing the capacity and resource issues putting strain on UK neovascular age-related macular degeneration (nAMD) services while promoting patients' best interests throughout.

methodsTwo structured roundtable meetings of retinal specialists were held in London, UK on 7 December 2018 and 1 March 2019. These meetings were organised and funded by Bayer.

resultsThe panel provided recommendations for an aflibercept T&E pathway and developed specific criteria based on visual acuity, retinal morphology and optical coherence tomography imaging to guide reduction, maintenance and extension of injection intervals. They also discussed the extension of treatment intervals by 2- or 4-week adjustments to a maximum treatment interval of 16 weeks, the management of retinal fluid and the stopping of treatment.

conclusionsThe long-term benefits of implementing a T&E pathway may include superior visual outcomes compared with a pro re nata (PRN; as needed) protocol, and a lower treatment burden compared with a fixed protocol, which is likely to improve service capacity. Furthermore, the predictable nature of a T&E approach compared with a PRN service may aid capacity planning for the future nAMD treatment demand.

Indexed as

Macular DegenerationWet Macular DegenerationAngiogenesis InhibitorsHumansIntravitreal InjectionsLondonRanibizumabReceptors, Vascular Endothelial Growth FactorRecombinant Fusion ProteinsTomography, Optical CoherenceTreatment OutcomeUnited KingdomafliberceptAngiogenesis InhibitorsRanibizumabReceptors, Vascular Endothelial Growth FactorRecombinant Fusion Proteins

Identifiers

PMID31900438
PMCPMC7608090

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.