Clinical outcomes of switching to aflibercept using a pro re nata treatment regimen in patients with neovascular age-related macular degeneration who incompletely responded to ranibizumab

Elwes, Flora; Borooah, Shyamanga; Aspinall, Peter; Sim, Peng Yong; Loo, Cheng Yi; Armbrecht, Ana Maria; Dhillon, Baljean; Cackett, Peter

doi:10.1186/s12886-018-0688-3

Cited by 3 publications

(1 citation statement)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In accordance to the literature (26)(27)(28)(29)(30)(31), our results show a benefit of a therapy switch to aflibercept for patients' refractory to ranibizumab. Only one study showed visual acuity improvement after aflibercept injection according to a fixed regimen (28). All other papers demonstrated a stable or worse visual acuity despite reduced retinal prominence or PED height, with various injection regimens applied (PRN, fixed, treat and extent).…”

Section: Discussionsupporting

confidence: 92%

Comparison of the therapy effect of aflibercept and ranibizumab in patients with neovascular retinal pigment epithelium detachment identified by fluorescence angiography and optical coherence tomography angiography

Ruebsam¹,

Dominika²,

Tina³

et al. 2019

Preprint

View full text Add to dashboard Cite

Background To report on the current methods for choroidal neovascularization (CNV) detection and the clinical outcome of intravitreal therapies in patients with neovascular pigment epithelium detachment (PED). Methods Retrospective, interventional cohort study on 77 eyes of 59 patients. Inclusion criteria were a neovascular PED, identified by fluorescence angiography (FA) or/and optical coherence tomography angiography (OCTA) treated with aflibercept (16 eyes) or ranibizumab monotherapy (36 eyes) or with at least three injections of ranibizumab, with a therapy switch to aflibercept in case of persistent fluid (25 eyes). The therapy regimen was a pro re nata (PRN) scheme with an upload phase of three monthly injections. Outcome measures were sensitivity of CNV detection and evaluation of CNV activity at baseline on FA compared to OCTA, the change in highest retinal prominence (HRP) and PED size, assessed by spectral - domain OCT (SD-OCT), and the change in best-corrected visual acuity (BCVA) three months after therapy initiation in the monotherapy groups or after the switch. Results Sensitivity of CNV detection was slightly superior for FA (0.786) compared to OCTA (0.706), whereas CNV activity evaluation was superior on OCTA. HRP significantly decreased after aflibercept (p<0.001) or ranibizumab monotherapy (p<0.001), and after therapy switch to aflibercept (p<0.001) in ranibizumab refractory patients. Corresponding BCVA improved in these groups, but without statistical significance (p=0.46; p = 0.11; p=0.19). PED size significantly decreased after aflibercept monotherapy (p=0.001) or after therapy switch to aflibercept (p<0.001), but not after ranibizumab. Conclusions The combination of FA and OCTA offers significantly improved visualisation, quantification, and predictability of CNV activity in neovascular PED. Aflibercept and ranibizumab are effective treatment options for neovascular AMD with PED, with a stronger effect of aflibercept on the PED itself. Furthermore, aflibercept appears to be a valuable tool for the management of patients unresponsive to ranibizumab.

show abstract

Section: Discussionsupporting

confidence: 92%

Comparison of the therapy effect of aflibercept and ranibizumab in patients with neovascular retinal pigment epithelium detachment identified by fluorescence angiography and optical coherence tomography angiography

Ruebsam¹,

Dominika²,

Tina³

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

Ten-year mortality and long-term visual acuity outcomes in patients with exudative age-related macular degeneration treated with intravitreal anti-vascular endothelial growth factor injections

et al. 2021

View full text Add to dashboard Cite

Purpose There are limited real-world data on long-term mortality and visual outcomes in patients treated with anti-vascular endothelial growth factor (VEGF) for exudative age-related macular degeneration (exudative AMD). We assessed 10-year mortality and clinical outcomes in exudative AMD patients treated with intravitreal therapy (IVT) anti-VEGF injections on a pro-re-nata (PRN) regime following a standard loading regime. Methods Retrospective cohort study of the first 216 exudative AMD patients receiving IVT anti-VEGF for exudative AMD at a public tertiary referral hospital in Scotland. Main outcome measures were mortality, cause of death and best-corrected visual acuity (BCVA). Results A total of 216 patients were included. Mean age at presentation was 79.1 years [standard deviation (SD) 6.9]. Mean follow-up duration was 6.6 years (SD 3.2) during which there was a mean 24.3 Early Treatment Diabetic Retinopathy Study (ETDRS) letter loss in BCVA (P < 0.0001). Patients received a mean of 2.2 (SD 1.8) injections per year of follow-up. Overall, 52.6% (113/216) died during the period studied. Observed annual mortality incidence risk was 6.5% (SD 3.1) and was found to be significantly lower (P = 0.0064) than the expected annual death incidence risk (9.6%, SD 1.5) based on age and sex standardised Scottish mortality risk. The most common causes of death were malignancies (21.3%) and infection (20.0%). Conclusions This study highlights the relatively good long-term prognosis in vision and mortality in exudative AMD treated with a PRN regime in the real world. Although the majority lost vision, the rate of decline was significantly slower than that which would have been experienced in the pre-anti-VEGF era and reassuringly standardised mortality risk was lower than the national average.

show abstract

Short-Term Results of Switch from Conbercept to Bevacizumab or Ranibizumab in Eyes with Persistent Neovascular Age-Related Macular Degeneration

Wang

Yao

et al. 2020

Journal of Ophthalmology

View full text Add to dashboard Cite

Purpose. To study the short-term anatomical and functional outcomes in patients with neovascular age-related macular degeneration (nAMD) who were previously treated with conbercept and switched to ranibizumab or bevacizumab due to persistent activity. Methods. This retrospective single-arm study included nAMD patients who were followed up for at least three months after switching from at least 3 monthly intravitreal conbercept injections to bevacizumab or ranibizumab for persistent choroidal neovascularization (CNV) activity. The demographic data, treatments, best-corrected visual acuity (BCVA), central macular thickness (CMT), and the height of pigmented epithelial detachment (PED) before and after switching were recorded and analyzed. Results. A total of 64 eyes of 64 patients were included with a mean follow-up of 9.6 ± 3.0 months. The average number of injections of conbercept was 3.6 ± 0.8 (range, 3–5) before switching. 18 eyes were switched to bevacizumab, and the other 46 eyes were switched to ranibizumab. After switching, mean BCVA slowly improved from 0.73 ± 0.48 to 0.64 ± 0.41 (p=0.0132) at one month after the last intravitreal injection of ranibizumab or bevacizumab during the mean follow-up of 4.4 ± 2.0 months. One month after switching, the mean CMT decreased significantly from 294.9 ± 121.8 μm to 230.9 ± 107.0 μm (p<0.0001) and kept stable during the follow-up. There was a significant reduction of maximum PED height (mPEDH) at the first month after switching (from 384.3 ± 340.3 μm to 287.2 ± 245.2 μm, p=0.0018) and kept stable during the follow-up. The mean PED height at foveal center (cPEDH) showed a regression over time after switching (from 169.3 ± 230.6 μm to 130.5 ± 180.2 μm, p=0.0227) and also kept stable during the follow-up. The proportion of patients with IRF was slightly increased but not statistically significant before switching. After switching, this proportion decreased significantly from 96.9% to 81.3% at one month after the first intravitreal injection of ranibizumab or bevacizumab (p=0.0086). The proportion of patients with SRF did not change significantly before and after switching. The mean decrease of mPEDH and cPEDH at the last follow-up after switching was significantly larger in the IVR subgroup than in the IVB subgroup (p=0.023 and 0.010). Conclusion. Our results indicate that switching from intravitreal conbercept injections to bevacizumab or ranibizumab can lead to significant improvement of CMT, PED, and IRF and slight improvement of BCVA in a short period of time for persistent nAMD patients.

show abstract

Clinical outcomes of switching to aflibercept using a pro re nata treatment regimen in patients with neovascular age-related macular degeneration who incompletely responded to ranibizumab

Cited by 3 publications

References 31 publications

Comparison of the therapy effect of aflibercept and ranibizumab in patients with neovascular retinal pigment epithelium detachment identified by fluorescence angiography and optical coherence tomography angiography

Comparison of the therapy effect of aflibercept and ranibizumab in patients with neovascular retinal pigment epithelium detachment identified by fluorescence angiography and optical coherence tomography angiography

Ten-year mortality and long-term visual acuity outcomes in patients with exudative age-related macular degeneration treated with intravitreal anti-vascular endothelial growth factor injections

Short-Term Results of Switch from Conbercept to Bevacizumab or Ranibizumab in Eyes with Persistent Neovascular Age-Related Macular Degeneration

Contact Info

Product

Resources

About