Aflibercept Therapy for Exudative Age-related Macular Degeneration Resistant to Bevacizumab and Ranibizumab

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.…”

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

“…Concerning the number of visits in the PRN group (including the end study visit) patients attended a total of 396 out of 468 planned visits (15.4% visit loss), with a mean number of visits of 11.02 ± 1.86 (7)(8)(9)(10)(11)(12)(13).…”

“…8,9 In recent studies, it has been considered as a treatment option for patients presenting with persistent/ resistant nAMD or with high recurrence rate. [9][10][11][12][13][14][15][16][17][18][19][20][23][24][25][26] Moreover, aflibercept has also been used as alternative treatment in patients treated successfully with ranibizumab or bevacizumab. 19 Additional activity of aflibercept may rely on higher binding affinity to VEGF-A and the ability to target VEGF-B and PlGF.…”