Skip to main content
Top

Open Access 03-02-2025 | Aflibercept | ORIGINAL RESEARCH

Treatment Interval Progression and Adherence to Observe-and-Plan Regimen for Neovascular Age-Related Macular Degeneration Treated with Aflibercept 2 mg

Authors: Leyla Turan, Andreas Arnold-Vangsted, Morten la Cour, Delila Hodzic-Hadzibegovic, Javad N. Hajari, Oliver N. Klefter, Miklos Schneider, Yousif Subhi

Published in: Ophthalmology and Therapy

Login to get access

Abstract

Introduction

Treatment burden of anti-vascular endothelial growth factor (VEGF) therapy for neovascular age-related macular degeneration (AMD) can be reduced with the Observe-and-Plan (O&P) regimen, which allows for an individualized treatment while reducing the number of injections and assessment visits. In this study, we evaluate detailed characteristics of treatment interval adjustment through individual follow-ups and evaluate adherence to the O&P regimen in a real-world setting in one of the largest centers in Europe.

Methods

This was a retrospective cohort study of treatment-naïve eyes with neovascular AMD that were treated with intravitreal aflibercept 2 mg in an O&P regimen who had persisting exudation after completion of loading dose. We evaluated decisions on adjustment of treatment intervals and adherence to the O&P regimen from a total of 5 follow-up visits. Data from visits and decision on treatment intervals were extracted from a treatment database.

Results

A total of 561 eyes were eligible for this study. Treatment intervals gradually increased from a 4-weeks interval (loading dose) to a wide distribution of intervals from 4-weeks to 12-weeks, and at the 5th follow-up 24.9% were followed without any treatment. In total, 209 eyes (49.5%) at the 5th follow-up (of 422 eyes present at the 5th follow-up) adhered to the treatment algorithm.

Conclusion

Aflibercept 2 mg in an O&P treatment regimen leads to a variety of treatment intervals, and some eyes may be overtreated. An important proportion of eyes deviate from the intended O&P treatment regimen. Our study contributes to understanding real-world implications of personalized treatment regimens.
Literature
1.
go back to reference Vision Loss Expert Group of the Global Burden of Disease Study, GBD 2019 Blindness and Vision Impairment Collaborators. Global estimates on the number of people blind or visually impaired by age-related macular degeneration: a meta-analysis from 2000 to 2020. Eye (London). 2024;2024(38):2070–82. Vision Loss Expert Group of the Global Burden of Disease Study, GBD 2019 Blindness and Vision Impairment Collaborators. Global estimates on the number of people blind or visually impaired by age-related macular degeneration: a meta-analysis from 2000 to 2020. Eye (London). 2024;2024(38):2070–82.
2.
go back to reference Sedeh FB, Scott DAR, Subhi Y, Sørensen TL. Prevalence of neovascular age-related macular degeneration and geographic atrophy in Denmark. Dan Med J. 2017;64:A5422.PubMed Sedeh FB, Scott DAR, Subhi Y, Sørensen TL. Prevalence of neovascular age-related macular degeneration and geographic atrophy in Denmark. Dan Med J. 2017;64:A5422.PubMed
3.
go back to reference Vangsted A, Thinggaard BS, Nissen AHK, Hajari JN, Klefter ON, Krogh Nielsen M, Sørensen TL, Grauslund J, Subhi Y. Prevalence of geographic atrophy in Nordic countries and number of patients potentially eligible for intravitreal complement inhibitor treatment: a systematic review with meta-analyses and forecasting study. Acta Ophthalmol. 2023;101:857–68.CrossRefPubMed Vangsted A, Thinggaard BS, Nissen AHK, Hajari JN, Klefter ON, Krogh Nielsen M, Sørensen TL, Grauslund J, Subhi Y. Prevalence of geographic atrophy in Nordic countries and number of patients potentially eligible for intravitreal complement inhibitor treatment: a systematic review with meta-analyses and forecasting study. Acta Ophthalmol. 2023;101:857–68.CrossRefPubMed
4.
go back to reference Bloch SB, Larsen M, Munch IC. Incidence of legal blindness from age-related macular degeneration in denmark: year 2000 to 2010. Am J Ophthalmol. 2012;153:209-213.e2.CrossRefPubMed Bloch SB, Larsen M, Munch IC. Incidence of legal blindness from age-related macular degeneration in denmark: year 2000 to 2010. Am J Ophthalmol. 2012;153:209-213.e2.CrossRefPubMed
5.
go back to reference Feng C, Krogh Nielsen M, Sørensen TL, Subhi Y. Systemic levels of C-reactive protein in patients with age-related macular degeneration: a systematic review with meta-analyses. Mech Ageing Dev. 2020;191: 111353.CrossRefPubMed Feng C, Krogh Nielsen M, Sørensen TL, Subhi Y. Systemic levels of C-reactive protein in patients with age-related macular degeneration: a systematic review with meta-analyses. Mech Ageing Dev. 2020;191: 111353.CrossRefPubMed
6.
go back to reference Nahavandipour A, Krogh Nielsen M, Sørensen TL, Subhi Y. Systemic levels of interleukin-6 in patients with age-related macular degeneration: a systematic review and meta-analysis. Acta Ophthalmol. 2020;98:434–44.CrossRefPubMed Nahavandipour A, Krogh Nielsen M, Sørensen TL, Subhi Y. Systemic levels of interleukin-6 in patients with age-related macular degeneration: a systematic review and meta-analysis. Acta Ophthalmol. 2020;98:434–44.CrossRefPubMed
7.
go back to reference Nielsen MK, Subhi Y, Molbech CR, Grønskov K, Sørensen TL. Distribution of risk alleles in patients with age-related macular degeneration. Dan Med J. 2020;67:A05190295.PubMed Nielsen MK, Subhi Y, Molbech CR, Grønskov K, Sørensen TL. Distribution of risk alleles in patients with age-related macular degeneration. Dan Med J. 2020;67:A05190295.PubMed
8.
go back to reference Subhi Y, Nielsen MK, Molbech CR, Liisborg C, Søndergaard HB, Sellebjerg F, Sørensen TL. The transcriptome of peripheral blood mononuclear cells in patients with clinical subtypes of late age-related macular degeneration. Immun Ageing. 2019;16:20.CrossRefPubMedPubMedCentral Subhi Y, Nielsen MK, Molbech CR, Liisborg C, Søndergaard HB, Sellebjerg F, Sørensen TL. The transcriptome of peripheral blood mononuclear cells in patients with clinical subtypes of late age-related macular degeneration. Immun Ageing. 2019;16:20.CrossRefPubMedPubMedCentral
9.
go back to reference Rozing MP, Durhuus JA, Krogh Nielsen M, Subhi Y, Kirkwood TB, Westendorp RG, Sørensen TL. Age-related macular degeneration: a two-level model hypothesis. Prog Retin Eye Res. 2020;76: 100825.CrossRefPubMed Rozing MP, Durhuus JA, Krogh Nielsen M, Subhi Y, Kirkwood TB, Westendorp RG, Sørensen TL. Age-related macular degeneration: a two-level model hypothesis. Prog Retin Eye Res. 2020;76: 100825.CrossRefPubMed
10.
go back to reference Hera R, Keramidas M, Peoc’h M, Mouillon M, Romanet JP, Feige JJ. Expression of VEGF and angiopoietins in subfoveal membranes from patients with age-related macular degeneration. Am J Ophthalmol. 2005;139:589–96.CrossRefPubMed Hera R, Keramidas M, Peoc’h M, Mouillon M, Romanet JP, Feige JJ. Expression of VEGF and angiopoietins in subfoveal membranes from patients with age-related macular degeneration. Am J Ophthalmol. 2005;139:589–96.CrossRefPubMed
11.
go back to reference Funk M, Karl D, Georgopoulos M, Benesch T, Sacu S, Polak K, Zlabinger GJ, Schmidt-Erfurth U. Neovascular age-related macular degeneration: intraocular cytokines and growth factors and the influence of therapy with ranibizumab. Ophthalmology. 2009;116:2393–9.CrossRefPubMed Funk M, Karl D, Georgopoulos M, Benesch T, Sacu S, Polak K, Zlabinger GJ, Schmidt-Erfurth U. Neovascular age-related macular degeneration: intraocular cytokines and growth factors and the influence of therapy with ranibizumab. Ophthalmology. 2009;116:2393–9.CrossRefPubMed
12.
go back to reference Tatar O, Adam A, Shinoda K, Stalmans P, Eckardt C, Lüke M, Bartz-Schmidt KU, Grisanti S. Expression of VEGF and PEDF in choroidal neovascular membranes following verteporfin photodynamic therapy. Am J Ophthalmol. 2006;142:95–104.CrossRefPubMed Tatar O, Adam A, Shinoda K, Stalmans P, Eckardt C, Lüke M, Bartz-Schmidt KU, Grisanti S. Expression of VEGF and PEDF in choroidal neovascular membranes following verteporfin photodynamic therapy. Am J Ophthalmol. 2006;142:95–104.CrossRefPubMed
13.
go back to reference Wong TY, Chakravarthy U, Klein R, Mitchell P, Zlateva G, Buggage R, Fahrbach K, Probst C, Sledge I. The natural history and prognosis of neovascular age-related macular degeneration: a systematic review of the literature and meta-analysis. Ophthalmology. 2008;115:116–26.CrossRefPubMed Wong TY, Chakravarthy U, Klein R, Mitchell P, Zlateva G, Buggage R, Fahrbach K, Probst C, Sledge I. The natural history and prognosis of neovascular age-related macular degeneration: a systematic review of the literature and meta-analysis. Ophthalmology. 2008;115:116–26.CrossRefPubMed
14.
go back to reference Subhi Y, Sørensen TL. Valsalva-related subretinal hemorrhage as a presenting symptom of polypoidal choroidal vasculopathy. Case Rep Ophthalmol Med. 2017;2017:9650287.PubMedPubMedCentral Subhi Y, Sørensen TL. Valsalva-related subretinal hemorrhage as a presenting symptom of polypoidal choroidal vasculopathy. Case Rep Ophthalmol Med. 2017;2017:9650287.PubMedPubMedCentral
16.
go back to reference Petri AS, Boysen K, Cehofski LJ, van Dijk EHC, Dysli C, Fuchs J, Mastropasqua R, Subhi Y. Intravitreal injections with vascular endothelial growth factor inhibitors: a practical approach. Ophthalmol Ther. 2020;9:191–203.CrossRefPubMedPubMedCentral Petri AS, Boysen K, Cehofski LJ, van Dijk EHC, Dysli C, Fuchs J, Mastropasqua R, Subhi Y. Intravitreal injections with vascular endothelial growth factor inhibitors: a practical approach. Ophthalmol Ther. 2020;9:191–203.CrossRefPubMedPubMedCentral
17.
go back to reference Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, Kim RY, MARINA Study Group. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med. 2006;355:1419–31.CrossRefPubMed Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, Kim RY, MARINA Study Group. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med. 2006;355:1419–31.CrossRefPubMed
18.
go back to reference Brown DM, Kaiser PK, Michels M, Soubrane G, Heier JS, Kim RY, Sy JP, Schneider S, ANCHOR Study Group. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med. 2006;355:1432–44.CrossRefPubMed Brown DM, Kaiser PK, Michels M, Soubrane G, Heier JS, Kim RY, Sy JP, Schneider S, ANCHOR Study Group. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med. 2006;355:1432–44.CrossRefPubMed
19.
go back to reference Mantel I, Niderprim SA, Gianniou C, Deli A, Ambresin A. Reducing the clinical burden of ranibizumab treatment for neovascular age-related macular degeneration using an individually planned regimen. Br J Ophthalmol. 2014;98:1192–6.CrossRefPubMed Mantel I, Niderprim SA, Gianniou C, Deli A, Ambresin A. Reducing the clinical burden of ranibizumab treatment for neovascular age-related macular degeneration using an individually planned regimen. Br J Ophthalmol. 2014;98:1192–6.CrossRefPubMed
20.
go back to reference Parvin P, Zola M, Dirani A, Ambresin A, Mantel I. Two-year outcome of an observe-and-plan regimen for neovascular age-related macular degeneration treated with Aflibercept. Graefes Arch Clin Exp Ophthalmol. 2017;255:2127–34.CrossRefPubMedPubMedCentral Parvin P, Zola M, Dirani A, Ambresin A, Mantel I. Two-year outcome of an observe-and-plan regimen for neovascular age-related macular degeneration treated with Aflibercept. Graefes Arch Clin Exp Ophthalmol. 2017;255:2127–34.CrossRefPubMedPubMedCentral
21.
go back to reference Subhi Y, Schneider M, Hajari JN, la Cour M. Injection burden and treatment intervals of aflibercept in observe-and-plan regimen for neovascular age-related macular degeneration. Acta Ophthalmol. 2024;102:821–7.CrossRefPubMed Subhi Y, Schneider M, Hajari JN, la Cour M. Injection burden and treatment intervals of aflibercept in observe-and-plan regimen for neovascular age-related macular degeneration. Acta Ophthalmol. 2024;102:821–7.CrossRefPubMed
22.
go back to reference Heier JS, Brown DM, Chong V, Korobelnik JF, Kaiser PK, Nguyen QD, Kirchhof B, Ho A, Ogura Y, Yancopoulos GD, Stahl N, Vitti R, Berliner AJ, Soo Y, Anderesi M, Groetzbach G, Sommerauer B, Sandbrink R, Simader C, Schmidt-Erfurth U, VIEW 1 and VIEW 2 Study Groups. Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration. Ophthalmology. 2012;119:2537–48.CrossRefPubMed Heier JS, Brown DM, Chong V, Korobelnik JF, Kaiser PK, Nguyen QD, Kirchhof B, Ho A, Ogura Y, Yancopoulos GD, Stahl N, Vitti R, Berliner AJ, Soo Y, Anderesi M, Groetzbach G, Sommerauer B, Sandbrink R, Simader C, Schmidt-Erfurth U, VIEW 1 and VIEW 2 Study Groups. Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration. Ophthalmology. 2012;119:2537–48.CrossRefPubMed
23.
go back to reference Potapenko I, la Cour M. Modelling and prognostication of growth in the number of patients treated for neovascular age-related macular degeneration. Acta Ophthalmol. 2021;99:e1348–53.CrossRefPubMed Potapenko I, la Cour M. Modelling and prognostication of growth in the number of patients treated for neovascular age-related macular degeneration. Acta Ophthalmol. 2021;99:e1348–53.CrossRefPubMed
24.
go back to reference Kusenda P, Caprnda M, Gabrielova Z, Kukova N, Pavlovic S, Stefanickova J. Understanding loss to follow-up in AMD patients receiving vegf inhibitor therapy: associated factors and underlying reasons. Diagnostics (Basel). 2024;14:400.CrossRefPubMed Kusenda P, Caprnda M, Gabrielova Z, Kukova N, Pavlovic S, Stefanickova J. Understanding loss to follow-up in AMD patients receiving vegf inhibitor therapy: associated factors and underlying reasons. Diagnostics (Basel). 2024;14:400.CrossRefPubMed
25.
go back to reference Subhi Y, Sørensen TL. Neovascular age-related macular degeneration in the very old (≥ 90 years): epidemiology, adherence to treatment, and comparison of efficacy. J Ophthalmol. 2017;2017:7194927.CrossRefPubMedPubMedCentral Subhi Y, Sørensen TL. Neovascular age-related macular degeneration in the very old (≥ 90 years): epidemiology, adherence to treatment, and comparison of efficacy. J Ophthalmol. 2017;2017:7194927.CrossRefPubMedPubMedCentral
26.
go back to reference Potapenko I, Kristensen M, Thiesson B, Ilginis T, Lykke Sørensen T, Nouri Hajari J, Fuchs J, Hamann S, la Cour M. Detection of oedema on optical coherence tomography images using deep learning model trained on noisy clinical data. Acta Ophthalmol. 2022;100:103–10.CrossRefPubMed Potapenko I, Kristensen M, Thiesson B, Ilginis T, Lykke Sørensen T, Nouri Hajari J, Fuchs J, Hamann S, la Cour M. Detection of oedema on optical coherence tomography images using deep learning model trained on noisy clinical data. Acta Ophthalmol. 2022;100:103–10.CrossRefPubMed
27.
go back to reference Taipale C, Lindholm JM, Laine I, Tuuminen R. Comparison of two different treat-and-extend protocols with aflibercept in wet age-related macular degeneration. Acta Ophthalmol. 2020;98:267–73.CrossRefPubMed Taipale C, Lindholm JM, Laine I, Tuuminen R. Comparison of two different treat-and-extend protocols with aflibercept in wet age-related macular degeneration. Acta Ophthalmol. 2020;98:267–73.CrossRefPubMed
28.
go back to reference Taipale C, Lindholm JM, Kaarniranta K, Tuuminen R. Comparison of two different treat-and-extend protocols with aflibercept in wet age-related macular degeneration: two-year results. Adv Ther. 2020;37:2256–66.CrossRefPubMed Taipale C, Lindholm JM, Kaarniranta K, Tuuminen R. Comparison of two different treat-and-extend protocols with aflibercept in wet age-related macular degeneration: two-year results. Adv Ther. 2020;37:2256–66.CrossRefPubMed
29.
go back to reference Ohji M, Takahashi K, Okada AA, Kobayashi M, Matsuda Y, Terano Y, ALTAIR Investigators. Efficacy and safety of intravitreal aflibercept treat-and-extend regimens in exudative age-related macular degeneration: 52- and 96-week findings from ALTAIR: a randomized controlled trial. Adv Ther. 2020;37:1173–87.CrossRefPubMedPubMedCentral Ohji M, Takahashi K, Okada AA, Kobayashi M, Matsuda Y, Terano Y, ALTAIR Investigators. Efficacy and safety of intravitreal aflibercept treat-and-extend regimens in exudative age-related macular degeneration: 52- and 96-week findings from ALTAIR: a randomized controlled trial. Adv Ther. 2020;37:1173–87.CrossRefPubMedPubMedCentral
30.
go back to reference Heier JS, Khanani AM, Quezada Ruiz C, Basu K, Ferrone PJ, Brittain C, Figueroa MS, Lin H, Holz FG, Patel V, Lai TYY, Silverman D, Regillo C, Swaminathan B, Viola F, Cheung CMG, Wong TY, TENAYA and LUCERNE Investigators. Efficacy, durability, and safety of intravitreal faricimab up to every 16 weeks for neovascular age-related macular degeneration (TENAYA and LUCERNE): two randomised, double-masked, phase 3, non-inferiority trials. Lancet. 2022;399:729–40.CrossRefPubMed Heier JS, Khanani AM, Quezada Ruiz C, Basu K, Ferrone PJ, Brittain C, Figueroa MS, Lin H, Holz FG, Patel V, Lai TYY, Silverman D, Regillo C, Swaminathan B, Viola F, Cheung CMG, Wong TY, TENAYA and LUCERNE Investigators. Efficacy, durability, and safety of intravitreal faricimab up to every 16 weeks for neovascular age-related macular degeneration (TENAYA and LUCERNE): two randomised, double-masked, phase 3, non-inferiority trials. Lancet. 2022;399:729–40.CrossRefPubMed
31.
go back to reference Lanzetta P, Korobelnik JF, Heier JS, Leal S, Holz FG, Clark WL, Eichenbaum D, Iida T, Xiaodong S, Berliner AJ, Schulze A, Schmelter T, Schmidt-Ott U, Zhang X, Vitti R, Chu KW, Reed K, Rao R, Bhore R, Cheng Y, Sun W, Hirshberg B, Yancopoulos GD, Wong TY, PULSAR Investigators. Intravitreal aflibercept 8 mg in neovascular age-related macular degeneration (PULSAR): 48-week results from a randomised, double-masked, non-inferiority, phase 3 trial. Lancet. 2024;403:1141–52.CrossRefPubMed Lanzetta P, Korobelnik JF, Heier JS, Leal S, Holz FG, Clark WL, Eichenbaum D, Iida T, Xiaodong S, Berliner AJ, Schulze A, Schmelter T, Schmidt-Ott U, Zhang X, Vitti R, Chu KW, Reed K, Rao R, Bhore R, Cheng Y, Sun W, Hirshberg B, Yancopoulos GD, Wong TY, PULSAR Investigators. Intravitreal aflibercept 8 mg in neovascular age-related macular degeneration (PULSAR): 48-week results from a randomised, double-masked, non-inferiority, phase 3 trial. Lancet. 2024;403:1141–52.CrossRefPubMed
32.
go back to reference Sevik MO, Aykut A, Özkan G, Dericioğlu V, Şahin Ö. The effect of COVID-19 pandemic restrictions on neovascular AMD patients treated with treat-and-extend protocol. Int Ophthalmol. 2021;41:2951–61.CrossRefPubMedPubMedCentral Sevik MO, Aykut A, Özkan G, Dericioğlu V, Şahin Ö. The effect of COVID-19 pandemic restrictions on neovascular AMD patients treated with treat-and-extend protocol. Int Ophthalmol. 2021;41:2951–61.CrossRefPubMedPubMedCentral
33.
go back to reference Borrelli E, Battista M, Vella G, Grosso D, Sacconi R, Querques L, Zucchiatti I, Prascina F, Bandello F, Querques G. The COVID-19 pandemic has had negative effects on baseline clinical presentation and outcomes of patients with newly diagnosed treatment-naïve exudative AMD. J Clin Med. 2021;10:1265.CrossRefPubMedPubMedCentral Borrelli E, Battista M, Vella G, Grosso D, Sacconi R, Querques L, Zucchiatti I, Prascina F, Bandello F, Querques G. The COVID-19 pandemic has had negative effects on baseline clinical presentation and outcomes of patients with newly diagnosed treatment-naïve exudative AMD. J Clin Med. 2021;10:1265.CrossRefPubMedPubMedCentral
34.
go back to reference Zarranz-Ventura J, Escobar-Barranco JJ, Gómez-Baldó L, Gallego-Pinazo R, Study Investigators. Reasons for delayed anti-VEGF treatment during COVID-19 lockdown and clinical impact in neovascular age-related macular degeneration. Ophthalmol Ther. 2023;12:2537–55.CrossRefPubMedPubMedCentral Zarranz-Ventura J, Escobar-Barranco JJ, Gómez-Baldó L, Gallego-Pinazo R, Study Investigators. Reasons for delayed anti-VEGF treatment during COVID-19 lockdown and clinical impact in neovascular age-related macular degeneration. Ophthalmol Ther. 2023;12:2537–55.CrossRefPubMedPubMedCentral
Metadata
Title
Treatment Interval Progression and Adherence to Observe-and-Plan Regimen for Neovascular Age-Related Macular Degeneration Treated with Aflibercept 2 mg
Authors
Leyla Turan
Andreas Arnold-Vangsted
Morten la Cour
Delila Hodzic-Hadzibegovic
Javad N. Hajari
Oliver N. Klefter
Miklos Schneider
Yousif Subhi
Publication date
03-02-2025
Publisher
Springer Healthcare
Published in
Ophthalmology and Therapy
Print ISSN: 2193-8245
Electronic ISSN: 2193-6528
DOI
https://doi.org/10.1007/s40123-025-01095-1

Keynote series | Spotlight on menopause

Menopause can have a significant impact on the body, with effects ranging beyond the endocrine and reproductive systems. Learn about the systemic effects of menopause, so you can help patients in your clinics through the transition.   

Prof. Martha Hickey
Dr. Claudia Barth
Dr. Samar El Khoudary
Developed by: Springer Medicine
Watch now

Keynote webinar | Spotlight on adolescent vaping

Growing numbers of young people are using e-cigarettes, despite warnings of respiratory effects and addiction. How can doctors tackle the epidemic, and what health effects should you prepare to manage in your clinics?

Prof. Ann McNeill
Dr. Debbie Robson
Benji Horwell
Developed by: Springer Medicine
Watch now

Keynote webinar | Spotlight on modern management of frailty

Frailty has a significant impact on health and wellbeing, especially in older adults. Our experts explain the factors that contribute to the development of frailty and how you can manage the condition and reduce the risk of disability, dependency, and mortality in your patients.

Prof. Alfonso Cruz-Jentoft
Prof. Barbara C. van Munster
Prof. Mirko Petrovic
Developed by: Springer Medicine
Watch now

A quick guide to ECGs

Improve your ECG interpretation skills with this comprehensive, rapid, interactive course. Expert advice provides detailed feedback as you work through 50 ECGs covering the most common cardiac presentations to ensure your practice stays up to date. 

PD Dr. Carsten W. Israel
Developed by: Springer Medizin
Start the cases

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Read more