Intravitreal aflibercept versus bevacizumab for treatment of myopic choroidal neovascularization

Abstract

The authors performed a retrospective and comparative study to compare the efficacy of intravitreal aflibercept and bevacizumab for patients with myopic choroidal neovascularization (mCNV). The patients with treatment-naïve mCNV received 1 + PRN intravitreal bevacizumab from March 2008 to February 2013, while from March 2013 to July 2016 patients were treated by 1 + PRN intravitreal aflibercept, all with monthly follow-up for 12 months. Primary outcome measures included change in central foveal thickness (CFT) in 1 mm by spectral-domain optic coherence tomography, and best corrected visual acuity (BCVA) at month 12. Complications after injections were recorded. The intra-group changes in CFT and BCVA were compared with Wilcoxon signed rank test, the between-group difference compared with Wilcoxon rank sum test. Fisher’s exact test was used for categorical comparison between groups. Seventy-eight eyes of 78 patients were collected. There were 42 eyes in bevacizumab group, with mean age of 53.2 ± 5.4 years and 27 female patients of them. The mean BCVA significantly improved from baseline 0.56 ± 0.35 logMAR to 0.35 ± 0.35 logMAR at Month 12 after bevacizumab treatment (p < 0.001). The mean CFT significantly decreased from baseline 315.3 ± 25.6 μm to 253.7 ± 24.4 μm at Month 12 following intravitreal bevacizumab (p < 0.001). There were 36 eyes in aflibercept group, with mean age of 52.8 ± 6.8 years and 24 female patients of them. The mean BCVA significantly improved from baseline 0.61 ± 0.47 logMAR to 0.38 ± 0.41 logMAR at Month 12 after aflibercept treatment (p < 0.001). The mean CFT significantly decreased from baseline 328.2 ± 19.8 μm to 241.8 ± 27.2 μm at Month 12 following intravitreal aflibercept (p < 0.001). The baseline demographics, lens status, axial length, refractive errors, duration of symptoms, BCVA, and CFT did not differ significantly between groups (p > 0.05). There was no significant difference between bevacizumab and aflibercept groups in BCVA and CFT from Month 1 to Month 12 (p > 0.05). Injection number of aflibercept was 2.11 ± 0.41, less than that of bevacizumab (3.23 ± 0.38) during 12-month period (p = 0.01). There were no systemic thromboembolic event, elevated intraocular pressure, retinal detachment, or infectious endophthalmitis following injections in both groups. We concluded that both aflibercept and bevacizumab can effectively treat choroidal neovascularization in high myopes. Intravitreal aflibercept had similar efficacy but less treatment number than bevacizumab for mCNV during 12-month period.

High‑dose aflibercept injection has striking effects on myopic choroidal neovascularization

“…The MYRROR trial, which adopted an as-needed aflibercept treatment for mCNV, indicated that the CMT rapidly decreased and reached stable levels between weeks 4 and 8. Such an early improvement of CMT was consistent with another retrospective clinical study, which compared bevacizumab to aflibercept in the treatment of mCNV (29). At week 48, in the MYRROR trial, the decrease in CRT was 86.2 µm, whereas in the present study, it was 122.63 µm (16).…”

Comparison of Intravitreal Aflibercept and Ranibizumab for Treatment of Myopic Choroidal Neovascularization: One-Year Results—A Retrospective, Comparative Study

“…In MYRROR trial, e.g., the CMT was reduced rapidly following the as-needed aflibercept treatment reaching the plateau levels between week 4 and week 8. Such an early improvement of CMT values was also reported in a recent retrospective clinical study comparing aflibercept to ranibizumab in mCNV patients [10].…”

“…In a more recent comparative retrospective study, Wang et al reported that both IVB and IVA treatments were equally effective in means of CMT reduction and visual gain at the end of the study period (Month 12) [10]. e IVA arm underwent significantly less injections (2.11 ± 0.41 versus 3.23 ± 0.38; p � 0.01) than IVB arm on an as-needed regimen.…”

“…Nowadays, the standard of care for mCNV is the intravitreal administration of anti-vascular endothelial growth factor (anti-VEGF) agents such as ranibizumab and bevacizumab, which have better clinical results compared to previous treatment modalities such as PDT leading these agents to the first-line therapy for mCNVs [7,8]. Several clinical comparisons and meta-analysis were conducted to find out which anti-VEGF agent had preferable clinical efficacy [9][10][11]. To the best of our knowledge, the current study is the first head-to-head comparison of aflibercept and ranibizumab in the treatment of mCNV patients.…”

Real-World Treatment Intensity and Patterns in Patients With Myopic Choroidal Neovascularization: Common Data Model in Ophthalmology

“…It might be the results of the increasing use of aflibercept which might have probable superiority in mCNV treatment: aflibercept is superior to ranibizumab in terms of better final visual outcomes, 35 and to bevacizumab in terms of less treatment intensity during 12-month period. 36 …”