One-Year Outcomes of Aflibercept in Recurrent or Persistent Neovascular Age-Related Macular Degeneration

Abstract

Purpose To evaluate 6-month and 1-year outcomes of every 8 weeks (Q8W) aflibercept in patients with resistant neovascular age-related macular degeneration (AMD). Design Retrospective, interventional, consecutive case series. Methods Retrospective review of patients with resistance (multiple recurrences or persistent exudation) to every 4 weeks (Q4W) ranibizumab or bevacizumab that were switched to Q8W aflibercept. Results Sixty-three eyes of 58 patients had a median of 13 (interquartile range (IQR), 7-22) previous anti Vascular Endothelial Growth Factor (anti-VEGF) injections. At 6-months after changing to aflibercept, 60.3% of eyes were completely dry, which was maintained up to one-year. The median maximum retinal thickness improved from 355 microns to 269 microns at 6 months (p<0.0001) and 248 microns at one year (p<0.0001). There was no significant improvement in ETDRS visual acuity at 6 months (p=0.2559) and one-year follow-up (p=0.1081) compared with baseline. The mean difference in ETDRS visual acuity compared to baseline at 6 months was −0.05 logMAR (+2.5 letters) and 0.04 logMAR at 1 year (−2 letters). Conclusion Sixty percent of eyes with resistant AMD while on Q4W ranibizumab or bevacizumab were completely dry after changing to Q8W aflibercept at the 6-month and 1-year follow-ups, but visual acuity did not significantly improve. Only a third of eyes needed to be switched from Q8W to Q4W aflibercept due to persistence of fluid; Q8W dosing of aflibercept without the initial 3 monthly loading doses may be a good alternative in a select group of patients who may have developed ranibizumab or bevacizumab resistance.

Aflibercept improves outcome in eyes with poor vision from neovascular age‐related macular degeneration

“…It is possible that in unresponsive patients, switching to a higher frequency of aflibercept injections would result in a more favorable outcome. (Arcinue et al 2015) Whereas, all our patients demonstrated a reduction in CRT following conversion, the visual function did not change accordingly, suggesting that in patients with continued visual deterioration despite anatomical stability, changing agents may be advised to achieve maximal therapeutic effect. …”

Efficacy of aflibercept on exudative age-related macular degeneration in patients exhibiting complete ranibizumab resistance and tachyphylaxis

“…In contrast, in our study, the dry macula and unchanged, increased, and decreased visual acuity rates at 3 months after the aflibercept injections were 38.1%, 42.9%, 42.8%, and 14.3%, respectively, in the tachyphylaxis group, and 39.1%, 43.5%, 34.7%, and 21.7%, respectively, in the complete resistance group. The high rate of dry macula in the study by Arcinue et al can be largely attributed to the inclusion of both recurrent and persistent cases in the working group (15) . Studies have shown that intravitreal aflibercept injections are also effective against other anti-VEGF resistant PEDs (3,27) .…”

“…A retrospective study by Arcinue et al, one of the most recent studies on this subject, observed an average visual acuity increase of 0.05 logMAR together with a dry macula in 60.3% of the eyes at the end of 6 months (15) . Additionally, visual acuity remained unchanged in 38.1% of the eyes, an increase of ≥1 line was observed in 36.5% of the eyes, and a decrease of ≥1 line was observed in 23.8% of the eyes.…”

“…However, the remaining patients did not achieve positive results, leading to the clinical outcome of permanent vision loss. Recently published studies have discussed the effectiveness of intravitreal aflibercept in cases involving insufficient responses to ranibizumab treatment and the development of recurrence and tolerance in subsequent months (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) . Additional studies have shown that a change of intravitreal agents might be effective in patients with neovascular…”

Aflibercept in diabetic macular edema: evaluating efficacy as a primary and secondary therapeutic option

“…37,38 This is in contrast to AMD where the effect of switching between anti-VEGFs in resistant cases has been studied extensively. [39][40][41][42][43][44][45] Switching to both aflibercept and ranibizumab has been attempted, with resistant cases usually showing variable degrees of improvement, making this strategy a reasonable option in cases of AMD.…”