<p>Adding a Corticosteroid or Switching to Another Anti-VEGF in Insufficiently Responsive Wet Age-Related Macular Degeneration</p>

Abstract

PurposeTo compare the effect of adding a corticosteroid or switching to another anti-VEGF treatment in patients with exudative age-related macular degeneration (eAMD) with persisting intraretinal fluid on anti-VEGF monotherapy.MethodsThis retrospective, interventional case series involved 43 pseudophakic eyes with eAMD and persistent intraretinal fluid on anti-VEGF treatment that switched treatment to a combination of Ozurdex® or Triamcinolone and anti-VEGF therapy (group 1) or to another anti-VEGF agent (group 2). The number of injections, time to re-injection, change in central retinal thickness (CRT), and best-corrected visual acuity (BCVA) from 12 months prior to 12 months after switch to third-line therapy were defined as primary outcomes.ResultsWhereas the treatment demand was reduced (from 8.8±2.2 to 4.6±2.9 injections; p=0.001) and the re-injection interval extended in group 1 (from 1.5±0.4 months to 4.4±3.8 months; p=0.001), these parameters did not change in group 2 (7.4±1.6 to 7.3±2.2; p=0.90 and 1.7±0.3 months to 1.9±0.8 months; p=0.75). Mean CRT decreased from 455.7±30.1 and 427.6±36.0µm (groups 1 and 2, respectively) to 359.1±38.2 and 303.1±44.4µm (intergroup p=0.03). The mean baseline BCVA of 62.6±3.8 letters (group 1) and 63.0±1.9 letters (group 2) remained stable under therapy in both groups (intergroup p=0.67).ConclusionIn eyes with eAMD with persistent intraretinal fluid on anti-VEGF monotherapy despite frequent re-injections, corticosteroids achieved a similar functional and morphological outcome over 12 months as switching to another anti-VEGF therapy, but with a reduced injection burden. In selected cases, corticosteroid treatment may thus be an option for third-line therapy in refractory exudative AMD.

Switching to Brolucizumab in Neovascular Age-Related Macular Degeneration Incompletely Responsive to Ranibizumab or Aflibercept: Real-Life 6 Month Outcomes

“…This confirms previous reports of a reduction in CST within the first 2 months after the switch to brolucizumab [ 5 , 6 , 7 ], and better morphological outcomes and a functional noninferiority compared to aflibercept over 2 years in two phase 3 studies [ 3 ]. Moreover, in accordance with previous studies, distance BCVA did not change significantly after switching from other anti-VEGF agents to brolucizumab, which is well in line with previous experiences of switching from ranibizumab to aflibercept [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. In contrast to these publications, a sustained reduction in CST after 6 months was not recorded in our cohort, which may be linked to insufficient power.…”

“…One patient with massive intraretinal fluid subjectively experienced further visual deterioration despite better visual acuity after one brolucizumab injection and requested to be switched back to the previous anti-VEGF therapy. In one patient, therapy was supplemented with intravitreal dexamethasone to reduce persistent injection burden by the attending physician, according to reported experience [ 8 ]. In the analysis of the excluded subset, no statistically significant change in BCVA or CST after 6 months compared to baseline was observed ( Table A1 , Appendix A ).…”

Biological drug therapy for ocular angiogenesis: Anti‐VEGF agents and novel strategies based on nanotechnology

“…Moreover, these therapies appeared as an alternative to laser surgery and chronic corticosteroid use, which can induce raise of the intraocular pressure and cataracts 60,61 . Currently, corticosteroids are widely used as co‐treatment to antiangiogenic therapy for ocular angiogenesis disorders 27,62 …”

“…However, this same comparison is not easily extrapolated for BD because they have little structural differences compared with the biological mechanics of the living organism used as source 18,21,22 . The BD spectrum of molecules can be quite broad: it can include therapies based on vaccines, antibiotics, interferons, recombinant fusion proteins (RFP), nucleic acids, and monoclonal antibodies (mAb), among others 24‐27 …”

Intravitreal Dexamethasone Implant as a Sustained Release Drug Delivery Device for the Treatment of Ocular Diseases: A Comprehensive Review of the Literature

“…The presence of an exudative neovascular lesion characterizes the exudative or neovascular form of AMD [99,100]. Although antiangiogenic therapy is considered the gold standard of treatment for exudative neovascular AMD, previous reports have also employed corticosteroids in the treatment of these patients [101][102][103][104][105][106][107]. The use of corticosteroids is based on the assumption that inflammation is known to play a major role in the AMD pathogenesis [103,108].…”