Paul Sternberg, MD: Perspectives on Step Therapy in Wet AMD Treatment

Although there are questions on the rationale behind step therapy, particularly for neovascular (wet) age-related macular degeneration, a recent presentation at the American Academy of Ophthalmology 2021 Meeting aimed to balance how people feel with the rationale behind its use.

In an interview with HCPLive, Paul Sternberg, MD, G.W. Hale Professor and Chair, Vanderbilt Eye Institute, discussed his advocacy for step therapy, despite noting there are reasonable reasons to question its use.

"I think that that if it's properly developed with physician input, that it can be an effective means to treating new vascular macular degeneration, and it can be much more cost effective," Sternberg said.

He noted one of the critical questions is the definition of failure used, whether that is visual acuity or optical coherence tomography (OCT). For this study, they have chosen visual acuity.

"We choose if patients have not shown any improvement in visual acuity over at least one set of four injections and, and I usually wait two sets of injections before I make that determination," he said.

He mentioned that data from the clinical trials show that only about 40% of patients show any significant improvement in visual acuity that means 60% will be the same or worse.

According, he pointed out that compliance with treatment is then a result of a relationship with a patient, regardless if they are receiving step therapy or any other form.

"If we made the presumption that patients are going to stop coming in, if they don't have improvement, we'd have a heck of a lot of patients that are not compliant with their treatment," Sternberg said.

Then, Sternberg discussed reduced costs as a result of step therapy, as patients get to start off with the less expensive drug and move up, rather than beginning with the more expensive drug.

"I think that the I personally feel that the kind of global opposition to step therapy is really not well founded," Sternberg said.

"What’s Wrong With Step Therapy for Wet AMD?," was presented at AAO 2021.