Morphology and Visual Acuity in Aflibercept and Ranibizumab Therapy for Neovascular Age-Related Macular Degeneration in the VIEW Trials

Waldstein, Sebastian M.; Simader, Christian; Staurenghi, Giovanni; Chong, Victor; Mitchell, Paul; Jaffe, Glenn J.; Lu, Chengxing; Katz, Todd A; Schmidt‐Erfurth, Ursula

doi:10.1016/j.ophtha.2016.03.037

Cited by 139 publications

(147 citation statements)

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“…In previous reports, some baseline characteristics might have been predictive of the treatment outcome,25,53 but it still remains to be elucidated. In the present study, BCVA at baseline was associated with BCVA at 2 years, and was similar to the 2-year outcome of aflibercept or ranibizumab therapy in patients with treatment-naïve AMD 18,54,55. Moreover, IRF at baseline was associated with BCVA at 2 years.…”

Section: Discussionsupporting

confidence: 82%

“…Indeed, the presence of IRF at baseline was associated with worse VA at 2 years in the Comparison of AMD Treatment Trial (CATT) study 57. Similarly, the VEGF Trap-Eye: Investigation of Efficacy and Safety in Wet AMD (VIEW 1 and VIEW 2) data suggested that eyes with baseline IRF had worse VA at week 52 than those without IRF 18,55. However, the significance of IRF as a biomarker in patients with PCV has not been reported.…”

Section: Discussionmentioning

confidence: 98%

“…Regarding the treatment regimens, multiple clinical trials have demonstrated the beneficial effect of fixed-dosing anti-VEGF treatments 9,15–18. In real-world practice, the majority of patients with AMD are given pro re nata or treat-and-extend (TAE) regimens to reduce various physical and financial burdens on both the patients and physicians,19–22 and a TAE dosing regimen showed similar visual outcomes with less injection numbers compared to fixed-dosing regimens 23…”

Section: Introductionmentioning

confidence: 99%

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Two-year outcome of treat-and-extend aflibercept after ranibizumab in age-related macular degeneration and polypoidal choroidal vasculopathy patients

Azuma¹,

Asaoka²,

Matsuda³

et al. 2018

OPTH

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BackgroundThe purpose of the study was to evaluate the 2-year outcome and predictive factors of treat-and-extend aflibercept in patients with eyes affected by typical neovascular age-related macula degenelation (t-AMD) or polypoidal choroidal vasculopathy (PCV), who were switched from ranibizumab.Patients and methodsThe patients underwent three monthly aflibercept injections and subsequent administration following the treat-and-extend protocol. Sixty-two eyes of 62 patients were reviewed retrospectively. R statistical software was used for statistical analysis.ResultsTwenty-two eyes were t-AMD and the remaining 40 eyes were PCV. There was no significant difference in the logarithm of the minimal angle of resolution visual acuity (VA) between baseline and 2 years after switching to aflibercept (0.40 vs 0.40; P=0.99). Multivariate analyses suggested that the following factors were significantly correlated with better VA at 2 years after switching to aflibercept: patients with PCV, the absence of intraretinal fluid at baseline, and better VA at baseline.ConclusionIn conclusion, VA was maintained and there was an anatomical improvement at 2 years in patients with t-AMD and PCV who were switched from ranibizumab to treat-and-extend aflibercept. PCV patients showed more favorable visual outcomes and less injections at 2 years compared to t-AMD patients. Intraretinal fluid and VA at baseline were predictors of VA at 2 years.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Two-year outcome of treat-and-extend aflibercept after ranibizumab in age-related macular degeneration and polypoidal choroidal vasculopathy patients

Azuma¹,

Asaoka²,

Matsuda³

et al. 2018

OPTH

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“…A post hoc analysis of the EXCITE study identified SRF as a predictor for greater best‐corrected visual acuity (BCVA) gains at 12 months of treatment (p = 0.05) (Waldstein et al. ,b). The presence of baseline SRF was associated with comparable visual gains at 12 months in patients receiving monthly and quarterly injections of ranibizumab (difference of +0.9 letters between both groups).…”

Section: Resultsmentioning

confidence: 99%

Age‐related macular degeneration: using morphological predictors to modify current treatment protocols

Ashraf

Souka

Adelman³

2017

Acta Ophthalmologica

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To assess predictors of treatment response in neovascular age-related macular degeneration (AMD) in an attempt to develop a patient-centric treatment algorithm. We conducted a systematic search using PubMed, EMBASE and Web of Science for prognostic indicators/predictive factors with the key words: 'age related macular degeneration', 'neovascular AMD', 'choroidal neovascular membrane (CNV)', 'anti-vascular endothelial growth factor (anti-VEGF)', 'aflibercept', 'ranibizumab', 'bevacizumab', 'randomized clinical trials', 'post-hoc', 'prognostic', 'predictive', 'response' 'injection frequency, 'treat and extend (TAE), 'pro re nata (PRN)', 'bi-monthly' and 'quarterly'. We only included studies that had an adequate period of follow-up (>1 year), a single predefined treatment regimen with a predetermined re-injection criteria, an adequate number of patients, specific morphological [optical coherence tomography (OCT)] criteria that predicted final visual outcomes and injection frequency and did not include switching from one drug to the other. We were able to identify seven prospective studies and 16 retrospective studies meeting our inclusion criteria. There are several morphological and demographic prognostic indicators that can predict response to therapy in wet AMD. Smaller CNV size, subretinal fluid (SRF), retinal angiomatous proliferation (RAP) and response to therapy at 12 weeks (visual, angiographic or OCT) can all predict good visual outcomes in patients receiving anti-VEGF therapy. Patients with larger CNV, older age, pigment epithelial detachment (PED), intraretinal cysts (IRC) and vitreomacular adhesion (VMA) achieved less visual gains. Patients having VMA/VMT required more intensive treatment with increased treatment frequency. Patients with both posterior vitreous detachment (PVD) and SRF require infrequent injections. Patients with PED are prone to recurrences of fluid activity with a reduction in visual acuity (VA). A regimen that involves less intensive therapy and extended follow-up intervals (4 weekly) can be suggested for patients who show adequate visual response and have both SRF and PVD at baseline. In addition, patients with poor prognostic indicators such as IRC, VMA, large CNV size, older age and poor response at 12 weeks should be extended very cautiously with the possibility of fixed monthly/bimonthly (every 2 months) treatments if they fail to achieve dryness. Patients with PED at baseline should receive monthly/bimonthly injections of anti-VEGF therapy or can be extended very cautiously (two weekly intervals) using a TAE protocol.

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“…OCT characteristics have been shown to be predictive for the treatment response in patients with age-related macular degeneration [20]. In general, morphologic features in DME have been described in detail and some characteristics graded at baseline found to be associated with a better treatment response to DME therapy [21–24].…”

Section: Discussionmentioning

confidence: 99%

Detailed analysis of retinal morphology in patients with diabetic macular edema (DME) randomized to ranibizumab or triamcinolone treatment

Karst

Lammer

Mitsch

et al. 2017

Graefes Arch Clin Exp Ophthalmol

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PurposeOur purpose was to compare the impact in diabetic macula edema (DME) of two intravitreal drugs (0.5 mg ranibizumab vs. 8 mg triamcinolone) on changes in retinal morphology in spectral-domain optical coherence tomography (SD OCT) images, color fundus photography (CF) and fluorescein angiography (FA) images during a 1-year follow-up.MethodsPost hoc analysis was conducted of morphologic characteristics in OCT, FA and CF images of eyes with a center involving DME that were included in a prospective double-masked randomized trial. Eligible patients were divided at random into two groups receiving either pro re nata treatment with 0.5 mg ranibizumab or 8 mg triamcinolone after a fixed loading dose. OCT and CF images were acquired at monthly visits and FA images every three months.ResultsTwenty-five eyes of 25 patients (ranibizumab: n = 10; triamcinolone: n = 15) were included in this study. Patients treated with ranibizumab showed better visual acuity results after 12 months than patients receiving triamcinolone (p = 0.015) although edema reduction was similar (p = 0.426) in both groups. The initial effect on macular edema shedding after a single ranibizumab injection could be amplified with the following two injections of the loading dose. After a single injection of triamcinolone the beneficial initial effect on the macula edema faded within 3 months. Subretinal fluid and INL cystoid spaces diminished early in the course of treatment while fluid accumulation in the ONL seemed to be more persistent in both treatment arms. In FA, the area of leakage diminished significantly in both treatment arms. After repeated injections the morphologic OCT and FA characteristics of the treatment arms converged.ConclusionsDespite the higher dosage of triamcinolone, both therapies were safe and effective for treating diabetic macular edema. Fluid accumulation in the INL and subretinal space was more responsive to therapy than fluid accumulation in the ONL. Clinicaltrials.gov: NCT00682539.

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Morphology and Visual Acuity in Aflibercept and Ranibizumab Therapy for Neovascular Age-Related Macular Degeneration in the VIEW Trials

Cited by 139 publications

References 13 publications

Two-year outcome of treat-and-extend aflibercept after ranibizumab in age-related macular degeneration and polypoidal choroidal vasculopathy patients

Two-year outcome of treat-and-extend aflibercept after ranibizumab in age-related macular degeneration and polypoidal choroidal vasculopathy patients

Age‐related macular degeneration: using morphological predictors to modify current treatment protocols

Detailed analysis of retinal morphology in patients with diabetic macular edema (DME) randomized to ranibizumab or triamcinolone treatment

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