Efficacy of aflibercept on exudative age-related macular degeneration in patients exhibiting complete ranibizumab resistance and tachyphylaxis

Gökçe, Gökçen; Durukan, Ali Hakan; Koylu, Mehmet Talay; Küçükevcilioğlu, Murat

doi:10.5935/0004-2749.20160109

Cited by 8 publications

(4 citation statements)

References 24 publications

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“…Lack of response to these therapies can be attributed to the phenomenon known as tachyphylaxis or tolerance (26,27). Preliminary studies suggested a decreased bioefficacy in AMD patients after repeated IVB (28).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of switching therapy to aflibercept for patients with persistent diabetic macular edema: a systematic review and meta-analysis

et al. 2020

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Background: To evaluate functional and anatomical consequences of switching anti-vascular endothelial growth factor (anti-VEGF) therapy from bevacizumab and/or ranibizumab to aflibercept intravitreal injection for the treatment of persistent diabetic macular edema (DME).Methods: Analysis of switching treatment in patients with persistent DME was performed using a literature search across multiple databases (PubMed, Medline, EMBASE, Cochrane Library and Web of Science) prior to May 2019. Therapeutic effect parameters, including mean change of best-corrected visual acuity (BCVA) and central macular thickness (CMT), were extracted from baseline to different follow-up times post initial injections. The quality of studies was assessed with the Downs and Black checklist. Data pertaining to ocular and systemic safety adverse events (SAEs) were collected as well as subgroup analysis stratified by preswitch anti-VEGF reagents. All results were analyzed and pooled using random-effects models with 95% confidence intervals (CI).Results: Fourteen studies involving 489 eyes met the inclusion criteria. The mean differences in BCVA were significantly improved at 1, 2 and 3 months with −0.11 logMAR (P=0.016), −0.22 logMAR (P<0.001) and −0.24 logMAR (P<0.01), respectively. Vision gain was also assessed following the aflibercept injection with a mean change of −0.10 logMAR (P<0.001) at 6 months and −0.08 logMAR (P=0.01) at 12 months.CMT reduction was significant from baseline with a mean decrease of 80.52 μm (P<0.001) at 1 month, 89.6 μm (P<0.013) at 2 months, 113.88 μm (P<0.001) at 3 months and 125.12 μm (P<0.001) at 6 months.Mean CMT continued to decline by 75.70 μm (P<0.001) at 12 months as well.Conclusions: This meta-analysis indicated the comparable efficacy and safety of a conversion treatment to aflibercept in cases of unsatisfactory responses to other anti-VEGF drugs. Switching treatment produces significant advantage for vision acuity recovery and macular edema improvement among persistent DME patients.

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Section: Discussionmentioning

confidence: 99%

Efficacy of switching therapy to aflibercept for patients with persistent diabetic macular edema: a systematic review and meta-analysis

et al. 2020

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“…Some authors advocate that unsatisfactory response in DME is diagnosed when reduction of retinal thickness is suboptimal; others define it as inadequate visual improvement, while others may combine several parameters [1115]. Suboptimal response in DME could be attributed to many post ulated mechanisms such as tachyphylaxis [1617] or tolerance (due to receptor dysregulation or neutralizing antibody formation against the anti-VEGF agent) [181920]. Many inf lammatory mediators have been implemented in the development and progression of diabetic retinopathy [21].…”

Section: Discussionmentioning

confidence: 99%

Switching to Aflibercept in Diabetic Macular Edema after Unsatisfactory Response to Other Anti-vascular Endothelial Growth Factor Drugs

Ibrahim

Eldaly

Saleh

et al. 2019

Korean J Ophthalmol

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Purpose To evaluate the efficacy of switching to aflibercept in diabetic macular edema (DME) with suboptimal response to previous anti-vascular endothelial growth factor (anti-VEGF) injections. Methods A prospective interventional case series study recruited patients from a single center diagnosed with DME with suboptimal response to anti-VEGF injections. Three consecutive monthly injections of aflibercept were performed. The primary outcome measure was mean change in visual acuity after switching to aflibercept. Results Forty-two patients (42 eyes) were included. Baseline logarithm of the minimum angle of resolution (logMAR) visual acuity was 0.87 ± 0.23 and improved significantly to 0.62 ± 0.29, 0.56 ± 0.34, and 0.46 ± 0.35 at 1, 2, and 3 months, respectively, after the first injection. Mean baseline retinal thickness was 451.57 ± 107.09 µm and decreased significantly at 1, 2, and 3 months after switching to aflibercept (346.52 ± 79.03, 328.24 ± 81.98, and 313.71 ± 85.79 µm, respectively). Both visual improvement and mean change in retinal thickness were significant in patients with pre-aflibercept best-corrected visual acuity less than 1.0 logMAR but were not significant in patients with best-corrected visual acuity more than 1.0 logMAR. Conclusions Switching to aflibercept in DME patients with an unsatisfactory response to previous anti-VEGF injections provided acceptable short-term visual and retinal architectural improvement.

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“…Recently, several studies discussed the development of anti-VEGF resistance and have demonstrated that the switch of intravitreal drug can be effective in treatment [15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Short-term results of early switch from Ranibizumab to Aflibercept in poor or non responder age related macular degeneration in clinical practice

et al. 2020

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Background: To evaluate the change in best corrected visual acuity (VA) and central macular thickness (CMT) following treatment with intravitreal aflibercept (AFL) in patients poorly responders or non responders to ranibizumab (RBZ). Methods: Charts of patients injected with RBZ from January 2016 to December 2018 (548 cases) due to neovascular age-related macular degeneration (nAMD) were reviewed. Fifty-six cases met our criteria for poor responders to RBZ (CMT decreased between 5 and 15% over treatment) or for non responders to RBZ (CMT decreased less than 5% or increased over treatment). Results: After the third AFL injection, CMT decreased from 384.38 ± 123.20 μm to 296.18 ± 70.52 μm in the nonresponder group and from 320.00 ± 82.05 μm to 282.27 ± 56.86 μm in the poor responder group. Although decrease in macular thickness was overall achieved 3 months after switching to AFL, it was not translated in VA improvement. Conclusions: it was observed that nAMD patients classified as RBZ non-responders tend to respond better to AFL than RBZ poor-responders anatomically, without correspondent improvement in VA.

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Efficacy of aflibercept on exudative age-related macular degeneration in patients exhibiting complete ranibizumab resistance and tachyphylaxis

Cited by 8 publications

References 24 publications

Efficacy of switching therapy to aflibercept for patients with persistent diabetic macular edema: a systematic review and meta-analysis

Efficacy of switching therapy to aflibercept for patients with persistent diabetic macular edema: a systematic review and meta-analysis

Switching to Aflibercept in Diabetic Macular Edema after Unsatisfactory Response to Other Anti-vascular Endothelial Growth Factor Drugs

Short-term results of early switch from Ranibizumab to Aflibercept in poor or non responder age related macular degeneration in clinical practice

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