Recommendation ID

Stopping rules for antiangiogenic treatment for late AMD (wet):- When should anti-vascular endothelial growth factor (VEGF) treatment be suspended or stopped
in people with late AMD (wet)?

Any explanatory notes
(if applicable)

Why this is important:- Anti-VEGF treatment is associated with inconvenience, risk of adverse events and – especially when aflibercept or ranibizumab is used – substantial costs. People typically receive anti-VEGF for extended periods, and it is unclear whether it is always beneficial. After successful treatment, the disease can become sufficiently dormant that treatment could be safely suspended. After ineffective treatment, there may be no benefit in continuing to treat eyes with advanced damage. The committee agreed that this gap in evidence could be addressed by a 2-stage research strategy. Observational research (for example, using registries recording administration of anti-VEGF and relevant outcomes) should be undertaken to establish the point at which the benefits of continuing treatment are unclear. This would involve eyes in which disease has responded well to treatment, and eyes in which pathological appearances or visual acuity suggest that disease is not responding to antiangiogenic treatment. This research should then be used to establish a protocol for suspending or stopping treatment. The protocol would be assessed in a non-inferiority randomised controlled trial (RCT) in which participants would be randomised to protocol-dependent stopping rules or usual care (continued treatment at clinician discretion). The committee agreed that the first step would be necessary to fulfil the ethical requirements of an RCT, as no consensus currently exists about the point(s) at which it may be safe to stop treatment.

Source guidance details

Comes from guidance
Age-related macular degeneration
Date issued
January 2018

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 30/01/2018