Aflibercept in persistent neovascular AMD: comparison of different treatment strategies in switching therapy

Ricci, Federico; Parravano, Mariacristina; Regine, Federico; Sciamanna, Marta; Tedeschi, Massimiliano; Missiroli, Filippo; Varano, Monica

doi:10.1038/eye.2016.95

Cited by 14 publications

(11 citation statements)

References 26 publications

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“…However, bimonthly injections provided BVCA improvement while patients in the PRN group only had stabilized visual acuity. Our good results with a fixed bimonthly protocol are consistent with a recent study by Ricci and al (10). In this study, the authors compared both treatment protocols, but in eyes treated with aflibercept after a switch from ranibizumab.…”

Section: Discussionsupporting

confidence: 93%

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Pro re Nata versus Bimonthly Regimen in Exudative AMD Treated with Aflibercept: 1-year Results

Keppi

Wolff²,

Castelnovo³

et al. 2017

Ophthalmology @ Point of Care

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Age-Related Macular Degeneration (ANCHOR) (4), and A Phase IIIb, Multicenter, Randomized, Double-Masked, Sham Injection-Controlled Study of the Efficacy and Safety of Ranibizumab in Subjects with Subfoveal Choroidal Neovascularization with or without Classic CNV Secondary to Age-Related Macular Degeneration (PIER) (5) have demonstrated the efficacy of monthly ranibizumab injections. Ophthalmologists have been able to reduce the number of injections based on the results of the Prospective Optical Coherence Tomography Imaging of Patients with Neovascular AMD Treated with Intraocular Ranibizumab (PRONTO) (6) study using a pro re nata (PRN) regimen. Pro re nata has been demonstrated to be as efficient as monthly injections in at least 2 randomized studies: Comparison of Age-related Macular Degeneration Treatment Trial (CATT) (7) and Alternative Treatments to Inhibit VEGF in Age-related Choroidal Neovascularization (IVAN) (8). In 2011, the VEGF Trap-Eye: Investigation of Efficacy and Safety in Wet AMD (VIEW) 1 and 2 studies (9) demonstrated that aflibercept could be injected bimonthly for 1 year with results as good as monthly ranibizumab injections. However, few studies have compared the PRN and the fixed bimonthly regimens. Only one recent study reported the effects of these 2 regimens in cases of a switch from ranibizumab to aflibercept in recurrent nAMD. In this study, the bimonthly protocol used after the switch seemed more efficient than PRN usage (10).

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Section: Discussionsupporting

confidence: 93%

“…Only one recent study reported the effects of these 2 regimens in cases of a switch from ranibizumab to aflibercept in recurrent nAMD. In this study, the bimonthly protocol used after the switch seemed more efficient than PRN usage (10).…”

Section: Introductionmentioning

confidence: 76%

Pro re Nata versus Bimonthly Regimen in Exudative AMD Treated with Aflibercept: 1-year Results

Keppi

Wolff²,

Castelnovo³

et al. 2017

Ophthalmology @ Point of Care

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“…Reported outcomes included BCVA changes and stability, changes in CRT, macular volume, and PED height. Overall, we included 8 prospective22–29 and 2030–49 retrospective studies, with a mean follow-up of at least 6 months after converting to aflibercept. Two articles included the same eyes at different times after conversion 23,24…”

Section: Resultsmentioning

confidence: 99%

Switching to aflibercept among patients with treatment-resistant neovascular age-related macular degeneration: a systematic review with meta-analysis

Spooner

Hong

Wijeyakumar

et al. 2017

OPTH

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PurposeTo systematically review anatomical and functional outcomes subsequent to switching from bevacizumab/ranibizumab to aflibercept monotherapy in patients with treatment-resistant neovascular age-related macular degeneration (nAMD).DesignSystematic review and meta-analysis.MethodsMedline, PubMed, Embase, and Cochrane databases were searched up to July 2016 for available scientific literature which met inclusion criteria. Eligible studies reported visual and anatomical outcomes with at least 6 months of follow-up among patients with nAMD and persistent or resistant exudative fluid despite previous anti-vascular endothelial growth factor (VEGF) therapy (bevacizumab and/or ranibizumab) and were switched to aflibercept monotherapy. Mean changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were pooled using random-effects models with 95% confidence intervals (CIs).ResultsOf 82 papers reviewed, 28 studies met inclusion criteria of this review. Pooled results showed a small mean improvement in BCVA at 6 and 12 months following switching (1.11 letters, 95% CI −0.25 to 2.46, P=0.17 and 0.63 letters, 95% CI −0.26 to 1.52, P=0.17, respectively). There was a significant improvement in mean CRT following switching (−61.90 µm, 95% CI −77.10 to −46.80, P<0.001 and −50.00 µm, 95% CI −63.20 to −36.80, P<0.001 at 6 and 12 months, respectively).ConclusionPooled analysis demonstrated significantly improved anatomical outcomes; however, visual function remained stable, having a comparable effect to other anti-VEGF agents in preservation of vision. These patients had poorly responsive chronic disease with limited potential for visual recovery. Switching to aflibercept with frequent monitoring may be a suitable option for patients who have developed treatment resistance.

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“…Some of the studies showed visual improvements,19,20,44 but others failed to include this information 21,25,43. The difference in treatment protocols may be one of the reasons for the different visual outcomes among the studies 45,46.…”

Section: Discussionmentioning

confidence: 99%

Two-year outcome of treat-and-extend aflibercept after ranibizumab in age-related macular degeneration and polypoidal choroidal vasculopathy patients

Azuma¹,

Asaoka²,

Matsuda³

et al. 2018

OPTH

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BackgroundThe purpose of the study was to evaluate the 2-year outcome and predictive factors of treat-and-extend aflibercept in patients with eyes affected by typical neovascular age-related macula degenelation (t-AMD) or polypoidal choroidal vasculopathy (PCV), who were switched from ranibizumab.Patients and methodsThe patients underwent three monthly aflibercept injections and subsequent administration following the treat-and-extend protocol. Sixty-two eyes of 62 patients were reviewed retrospectively. R statistical software was used for statistical analysis.ResultsTwenty-two eyes were t-AMD and the remaining 40 eyes were PCV. There was no significant difference in the logarithm of the minimal angle of resolution visual acuity (VA) between baseline and 2 years after switching to aflibercept (0.40 vs 0.40; P=0.99). Multivariate analyses suggested that the following factors were significantly correlated with better VA at 2 years after switching to aflibercept: patients with PCV, the absence of intraretinal fluid at baseline, and better VA at baseline.ConclusionIn conclusion, VA was maintained and there was an anatomical improvement at 2 years in patients with t-AMD and PCV who were switched from ranibizumab to treat-and-extend aflibercept. PCV patients showed more favorable visual outcomes and less injections at 2 years compared to t-AMD patients. Intraretinal fluid and VA at baseline were predictors of VA at 2 years.

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Aflibercept in persistent neovascular AMD: comparison of different treatment strategies in switching therapy

Cited by 14 publications

References 26 publications

Pro re Nata versus Bimonthly Regimen in Exudative AMD Treated with Aflibercept: 1-year Results

Pro re Nata versus Bimonthly Regimen in Exudative AMD Treated with Aflibercept: 1-year Results

Switching to aflibercept among patients with treatment-resistant neovascular age-related macular degeneration: a systematic review with meta-analysis

Two-year outcome of treat-and-extend aflibercept after ranibizumab in age-related macular degeneration and polypoidal choroidal vasculopathy patients

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