“Triple and Plan” (TriPla) regimen for long lasting new generation intravitreal anti-VEGF

Abstract

Intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) medications are the primary treatment for neovascular age-related macular degeneration (nAMD). However, frequent administrations pose significant burdens on patients, healthcare providers, and systems. The treat-and-extend (T&E) regimen, which adjusts treatment intervals based on patient response, aims to reduce injection frequency while maintaining disease control. The “Triple and Plan” (TriPla) regimen, developed during the COVID-19 pandemic, further optimizes treatment by scheduling three consecutive injections, thus minimizing clinic visits while ensuring adequate treatment.

Newer agents such as Faricimab, Aflibercept 8 mg, and Brolucizumab offer longer-lasting effects, potentially extending treatment intervals. Faricimab, targeting both Ang-2 and VEGF-A, requires fewer injections and visits under the TriPla regimen compared to traditional T&E. Aflibercept 8 mg, with its higher concentration, promises extended intervals up to 16 weeks, reducing the injection frequency. Brolucizumab, notable for its small size and effective tissue penetration, also offers prolonged therapeutic effects but requires careful monitoring due to potential adverse events.

In the first two years of treatment, patients using the TriPla regimen with these new drugs would undergo a slightly higher number of injections but with fewer clinic visits compared to the T&E regimen. The TriPla approach optimizes scheduling and reduces the workload on specialists, potentially improving patient care and healthcare system efficiency. These advancements in treatment regimens and drug formulations present significant benefits in managing nAMD, balancing effective disease control with reduced healthcare burdens.