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1、1/15/2013TREATANDEXTENDSHERIFEMBABI,MDAinShamsUniversity,CairoAMDTreatmentProtocols?Monthlyinjections:standardofcare?Alternativeindividualizedtreatmentstrategies:?PRN(treatandobserve)?PrONTOprotocol(treatandobserve).?TreatandextendorInjectandextend.11/15/2013Whatistreatand
2、extend??Thedosingstrategyconsistsofaninitialinductionor‘‘loading’’sequenceofatleastthreeinitialmonthlyinjections.?Ifstablevisualacuity,anabsenceofmacularhemorrhage,andadryOCThavebeenachievedatthispoint,patientscontinuetoreceiveregularmaintenanceinjectionsatincreasinginterv
3、als.Whatistreatandextend??At6weeksafterthelastofthe3initialmonthlyinjections,visualacuity,clinicalfindings,andOCTchangesarerecordedagain,andpatientsreceiveaninjectionregardlessofthepresenceorabsenceofdiseaseactivity.21/15/2013Whatistreatandextend??However,theintervaltothen
4、extvisit(andscheduledinjection)isbasedonanobservedchangeintheseparameters.?Iftherearenochanges,thenextvisitforexaminationandinjectionisscheduledfor8weeks.Ifthereisachange,thepatientreturnsforanotherscheduledinjectionandexaminationafter4weeks.Whatistreatandextend??Theobserv
5、ationandscheduledtreatmentintervalisextended(hencethephrase‘‘treatandextend’’)?10weeksandsometimes12weekswaschosenasthelongestintervalbetweenofficevisitsandtreatments.31/15/2013Whatistreatandextend??Baseline?After3monthly(4weeks)injections?Extendedto6weeksintervals?Extende
6、dto8weeksintervals?Extendedto10weeksintervals?Backto8weeksWhatarethedisadvantagesoftreatandobserve(PRN/PrONTO)?Thisstrategydoesrequiremonthlyvisits,clinicalexaminations,andOCTs.Thismeansmorefrequentvisitswhichisahugeburdenonthepatient(elderly)andtheirfamiliesandhealthcares
7、ystem!41/15/2013Whatarethedisadvantagesoftreatandobserve(PRN/PrONTO)??Patientsuncertain(anddoctorstoo!)iforwhentheywillneedtreatment?!Andthismaybeareasonforsomepatientstoskipvisits!Whatarethedisadvantagesoftreatandobserve(PRN/PrONTO)??Somepatientsmanagedwiththisstrategywil
8、lreturnforassessmentshavingalreadydevelopedhemorrhagesintheinjection-freeintervalwithirre
