Injection frequency and anatomic outcomes 1 year following conversion to aflibercept in patients with neovascular age-related macular degeneration

Messenger, Wyatt; Campbell, J. Peter; Faridi, Ambar; Shippey, Loton; Bailey, Steven T.; Lauer, Andreas K.; Flaxel, Christina J.; Hwang, Thomas S.

doi:10.1136/bjophthalmol-2013-304829

Cited by 45 publications

(31 citation statements)

References 10 publications

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“…There are several papers reporting similar results after switching to aflibercept in refractory or recurrent neovascular AMD. In the same direction as our results, these reports pointed to stable vision, while the anatomic outcomes improved and the number of treatments diminished [19,30,32,33,34,35,36]. Only Kumar et al [31] and Chang et al [37] described significant gains in visual acuity with the switch to aflibercept in treatment-resistant neovascular AMD.…”

Section: Discussionsupporting

confidence: 84%

Switch to Aflibercept in the Treatment of Neovascular AMD: One-Year Results in Clinical Practice

Pinheiro-Costa¹,

Costa²,

Beato³

et al. 2015

Ophthalmologica

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Purpose: To report the clinical outcomes of intravitreal aflibercept therapy in eyes with refractory and recurrent neovascular age-related macular degeneration (AMD) switched from intravitreal bevacizumab or ranibizumab. Methods: This is a retrospective review of eyes with neovascular AMD switched to intravitreal aflibercept with at least 1 year of follow-up after the switch. All patients had had a minimum of 3 injections of bevacizumab or ranibizumab before the switch. Aflibercept was used in patients considered refractory to bevacizumab (group 1) and in recurrent patients on therapy with ranibizumab due to an institutional policy decision (group 2). Changes in best-corrected visual acuity, fluid on optical coherence tomography (OCT), central retinal thickness (CRT) and the frequency of injections were compared. Results: Eighty-five eyes of 69 patients were analyzed, 39 eyes in group 1 and 46 in group 2. The mean follow-up time was 31.6 months prior to the switch and 14.7 months on treatment with aflibercept. One year after the switch, there was a nonsignificant mean decrease of 2 letters in visual acuity in both groups (group 1: from 58.2 to 55.8 letters, p = 0.086; group 2: from 56.4 to 54.5 letters, p = 0.168), but the mean number of injections per month was significantly lower (from 0.76 to 0.57, p < 0.001). With the switch, 90.6% of the patients showed anatomic improvement with a reduction of fluid on OCT, and both groups presented significant improvement in CRT (group 1: 65.3 µm, p = 0.051; group 2: 91.0 µm, p < 0.001). Conclusion: Aflibercept appears to be a valuable tool for the management of patients with poor responses to other anti-vascular endothelial growth factor drugs. These patients could have anatomic improvement, and the injection intervals could be extended.

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Section: Discussionsupporting

confidence: 84%

Switch to Aflibercept in the Treatment of Neovascular AMD: One-Year Results in Clinical Practice

Pinheiro-Costa¹,

Costa²,

Beato³

et al. 2015

Ophthalmologica

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“…In the study of Messenger et al, 15 where nAMD switched eyes have been treated at investigator discretion, and in the study of Grewal et al, 16 where recalcitrant nAMD switched to aflibercept have been treated with a fixed regimen, a stabilization of visual acuity after 1 year, associated with anatomical improvement, was reported.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 The availability of different anti-VEGF therapies offers the opportunity to switch from one anti-VEGF agent to another in subjects who still have active lesions after anti-VEGF treatment. [9][10][11][12][13][14][15][16][17][18][19][20] There have been several case series describing the outcome of switching from ranibizumab and/or bevacizumab to aflibercept in poor responders with nAMD. Different treatment regimens of aflibercept have been adopted for the switch and no clear dosing recommendations have been made.…”

Section: Introductionmentioning

confidence: 99%

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

Ricci

Parravano

Regine

et al. 2016

Eye

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Purpose To evaluate the effects of aflibercept administered according to a pro re nata (PRN) or Fixed Regimen to patients with neovascular AMD and persistent intraretinal/ subretinal fluid (IRF/SRF) despite three consecutive ranibizumab injections. Methods Patients were switched to aflibercept injection (IVA) administered according to a PRN or to a fixed regimen for 1 year in two different retina centers. At baseline each patient underwent a complete ophthalmologic evaluation, including bestcorrected visual acuity assessment (BCVA ETDRS chart), fluorescein, and indocyanine green angiography and OCT. Results Each group included 36 eyes. After 1 year the PRN group showed BCVA stabilization (63 vs 60 letters, P = 0.33), whereas fixed regimen group showed significant BCVA improvement (68 vs 71, P = 0.008). The median central retinal thickness decreased by 94 μm in the PRN (P = 0.002) and by 148 μm in the fixed regimen group (P ≤ 0.001). Complete IRF/SRF reabsorption was found in 58% of eyes in the PRN and in 42% of eyes in the fixed regimen group. At 1-year visit, the percentage of eyes with pigment epithelium detachment did not significantly decrease, but a height reduction was recorded in both groups. The median number of IVA was 3.5 in the PRN and 7 in the fixed regimen group. Conclusion The switch to aflibercept with both treatment strategies enabled improvement in morphological parameters and stabilization of visual acuity. BCVA improvement and reduction in vision loss with reduction in retinal thickness, fluid and PED height was achieved with the fixed regimen in previously treated nAMD after 1 year.

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“…4 A reduction of up to 3 injections per year has been reported following conversion to aflibercept at 1 year. 8 Limitations of this current study include its retrospective nature, limited sample size, and a treat-andextend protocol that may have induced physician bias.…”

Section: Discussionmentioning

confidence: 99%

Transitioning to intravitreal aflibercept following a previous treat-and-extend dosing regimen in neovascular age-related macular degeneration: 24-month results

Homer

Grewal

Mirza

et al. 2015

Eye

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Purpose: To evaluate frequency of injections, visual and anatomical outcomes of neovascular age-related macular degeneration (nAMD) patients transitioned to intravitreal aflibercept after failure to extend treatment interval beyond 8 weeks with prior intravitreal bevacizumab or ranibizumab. Methods: Retrospective review of patients with nAMD switched to aflibercept following ≥ 6 prior intravitreal ranibizumab or bevacizumab injections at 4-8-week intervals. Three monthly aflibercept injections were given followed by a treat-and-extend dosing regimen. Results: Twenty-one eyes of 18 patients who had received a mean of 23.8 ± 18.8 (mean ± SD; range 6-62) prior ranibizumab or bevacizumab injections were included. Over a mean follow-up of 24 months after the transition, 9.2 ± 2.9 (range 4-21) aflibercept injections were required. Interval between aflibercept injections increased to 57.3 days (range 35-133 days), as compared with 37 ± 6.1 days (range 29-54 days) with the prior agents (P = 0.01). Mean best-corrected visual acuity was preserved (0.42 ± 0.31 vs 0.42 ± 0.23 logMAR; P = 0.2). Mean OCT central subfoveal thickness (292.1 ± 83.2 μm to 283.6 ± 78.6 μm; P = 0.4) and mean macular volume (7.9 ± 0.95 mm 3 to 7.67 ± 0.94 mm 3 ; P = 0.16) remained stable. Conclusion: Patients requiring treatment more frequently than every 8 weeks with ranibizumab and bevacizumab were transitioned to 48-week treatment interval with aflibercept while maintaining the anatomic and visual gains.

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Injection frequency and anatomic outcomes 1 year following conversion to aflibercept in patients with neovascular age-related macular degeneration

Cited by 45 publications

References 10 publications

Switch to Aflibercept in the Treatment of Neovascular AMD: One-Year Results in Clinical Practice

Switch to Aflibercept in the Treatment of Neovascular AMD: One-Year Results in Clinical Practice

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

Transitioning to intravitreal aflibercept following a previous treat-and-extend dosing regimen in neovascular age-related macular degeneration: 24-month results

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