Aflibercept for exudative AMD with persistent fluid on ranibizumab and/or bevacizumab

Abstract

A significant proportion of exudative AMD cases with persistent fluid on OCT despite regular ranibizumab 0.5 mg and/or bevacizumab 1.25 mg treatment respond anatomically to aflibercept 2.0 mg. Visual acuity did not improve. Aflibercept may be beneficial anatomically in cases of exudative AMD treated with persistent fluid on ranibizumab and/or bevacizumab.

Defining response to anti-VEGF therapies in neovascular AMD

“…There is emerging evidence that responses to anti-VEGF therapy in n-AMD may also be influenced by the genetic profile of the individual. 18 If optimum treatment is confirmed with the previous treatment of choice, the clinician may consider changing therapy to a different anti-VEGF agent 58,[61][62][63][64][65] or PDT. 11,12 Conflict of interest WA has provided consultancy services to Alcon, Allergan, Bayer, Novartis and Thrombogenics.…”

“…27 However, there is emerging evidence that switching from one anti-VEGF therapy to another may result in increased response. [61][62][63][64][65] Non-clinical factors for less frequent treatment in NHS care in England include poor access to services, appointment delays and other systems failures. 66 Similar delay in access to services has been recorded in Canada, 67 Spain 68 and Germany.…”

“…If the fluid subsequently increases after dose withholding, the lesion would be considered 'active' and treatment recommenced with the same or alternative anti-VEGF agent. 58,[61][62][63][64][65] Eyes that demonstrate no significant benefit during the first 4 months of optimal anti-VEGF therapy may be considered to have failed to meet treatment targets (primary failure). Such patients should therefore be re-assessed and, if necessary, alternative therapies including other anti-VEGFs and PDT recommended as necessary subject to lesion characteristics.…”

Visual and anatomical outcomes following intravitreal aflibercept in eyes with recalcitrant neovascular age-related macular degeneration: 12-month results

“…[4][5][6][7][8][9] Potential explanations for the overall anatomic success of aflibercept therapy in recalcitrant eyes include tachyphylaxis, pharmacogenetics, or the increased binding affinity of aflibercept.…”

“…2 Efforts have also focused on switching these eyes to aflibercept. [3][4][5][6] In this case series review, we analyze the visual and anatomical changes following 12 months of intravitreal aflibercept in previously treated patients with recalcitrant exudative-AMD.…”