Review SUSPENDING TREATMENT OF NEOVASCULAR AGE-RELATED MACULAR DEGENERATION IN CASES OF FUTILITY Downloaded from https://journals.lww.com/retinajournal by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3GqhOzspyl8wqlYeI5gVyO0/66CMwvb7m1/wl0GleQks= on 04/29/2020
DAVID T. WONG, MD,*† GEORGE N. LAMBROU, MD,‡ ANAT LOEWENSTEIN, MD,§ IAN PEARCE, MB,¶ ANNABELLE A. OKADA, MD, DMSC,** ON BEHALF OF THE VISION ACADEMY STEERING COMMITTEE Purpose: To provide guidance on the management of patients with neovascular agerelated macular degeneration and its subtypes who respond poorly to anti–vascular endothelial growth factor (anti-VEGF) therapy, and to identify cases where suspending anti-VEGF treatment may be warranted. Methods: Through a literature review and the combined knowledge and clinical experience of retinal experts, the Steering Committee of the Bayer-sponsored Vision Academy developed an algorithm for determining when to suspend anti-VEGF treatment of neovascular age-related macular degeneration in cases of futility. Results: Consideration of factors that may cause suboptimal response to anti-VEGF therapy, such as undertreatment or misdiagnosis of the underlying condition, and factors that may preclude continued treatment, such as injection- or drug-induced complications, is necessary for adjusting treatment protocols in patients who respond poorly to anti-VEGF. If poor response to treatment persists after switching to an alternative anti-VEGF agent and no change in response is observed after withholding treatment for a predetermined period of time (“treatment pause”), anti-VEGF treatment may be considered futile and should be suspended. Conclusion: This publication introduces an algorithm to guide the management of neovascular age-related macular degeneration in patients showing poor response to antiVEGF treatment and provides expert guidance for suspending anti-VEGF treatment in cases of futility. RETINA 00:1–11, 2019
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The Vision Academy is an initiative that brings together global leaders in ophthalmology, providing a forum to share skills and knowledge. Together, Vision Academy members seek to address key clinical challenges in the field of retinal disease, providing outputs to build best practice and lead the wider ophthalmic community in the drive toward optimized, compassionate patient care. As a key area of uncertainty that may have a significant impact on the clinical management of patients with nAMD, determining futility of anti-VEGF treatment falls within the scope of the Vision Academy. Members of the Vision Academy Steering Committee (Appendix 1) met in 2017 to discuss the concept of treatment futility in nAMD, with particular focus on
edical futility is defined as the point at which a treatment has no realistic chance of providing an effect that the patient would have the capacity to appreciate as a benefit.1 Medical futility has two components: quantitative medical futility, which is related to the success of a treatment in achieving the intended goals, and qualitative medical futility, which is related to the value of a treatment to quality of life of the patient.1,2 Currently, there is variation in opinion and a lack of guidance within the ophthalmic community on when it may be appropriate to suspend anti– vascular endothelial growth factor (anti-VEGF) treatment of neovascular age-related macular degeneration (nAMD) in cases of medical futility.
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