Real World Data About the Treatment of Wet Age-Related Macular Degeneration in Kuopio University Hospital During 2019–2021 Using a PRN Regimen

Purpose: To evaluate the real-world effectiveness of a pro re nata (PRN) anti–vascular endothelial growth factor (anti-VEGF) regimen for neovascular age-related macular degeneration (nAMD) during 2019– 2021 at Kuopio University Hospital, including the COVID-19 pandemic period. Methods: This retrospective study included 107 patients (162 eyes) treated with intravitreal anti-VEGF injections for nAMD. The included eyes were not treatment-naive at study entry but had received anti-VEGF treatment before 2019. Annual injection numbers, drug choice (bevacizumab or aflibercept 2 mg), central retinal thickness (CRT), and visual acuity (VA) were analyzed from diagnosis through 2021 using independent-sample t-tests. Results: The mean number of injections in the first treatment year was 6.79 ± 2.32. During 2019– 2021, annual means were 5.09 ± 2.33, 5.40 ± 2.10, and 4.96 ± 2.11, respectively. Bevacizumab-treated eyes received significantly more injections than aflibercept-treated eyes across all years (p < 0.01 for 2019; p < 0.05 for 2020– 2021). Mean VA declined from 70 ± 57 ETDRS letters at diagnosis to 62 ± 57 ETDRS letters by late 2021 (p < 0.0001). In the aflibercept-only subgroup, the decline was smaller and not significant (68 ETDRS letters ± 55 ETDRS letters to 66 ± 56 ETDRS letters; p > 0.27). CRT decreased significantly from 388.4 ± 139.4 μm at diagnosis to 320.8 ± 114.7 μm in 2019 and remained stable thereafter (p < 0.0001 vs. baseline; p > 0.5 between years). Conclusion: The PRN regimen maintained anatomical outcomes but resulted in gradual visual decline, likely due to fewer injections, particularly during the COVID-19 period. Aflibercept required fewer injections without compromising outcomes. Transitioning toward a treat-and-extend protocol may enhance visual stability and cost-effectiveness in nAMD care. Keywords: AMD, PRN, cost-effectiveness, anti-VEGF