One-year real-world outcomes in patients receiving fixed-dosing aflibercept for neovascular age-related macular degeneration

Abstract

Purpose To investigate 1-year visual and anatomic outcomes of intravitreal aflibercept for neovascular age-related macular degeneration (nAMD) given at a fixed 8-weekly interval. Methods Retrospective, single-practice data analysis from an electronic medical record system of 255 eyes (223 patients) with treatment-naïve nAMD receiving 8-weekly aflibercept.Results Mean logarithm of the minimum angle of resolution best-corrected visual acuity (BCVA) improved from 0.66 at baseline to 0.50 at month 11 (Po0.0001). Mean central retinal thickness (CRT) decreased from 311μm at baseline to 211μm at month 11 (Po0.0001). Our mean VA gain of eight ETDRS letters was comparable to the VIEW 1 and VIEW 2 Trials' results at the end of year 1. After loading at month 5, mean BCVA was 0.48 (Po0.0001), and mean CRT was 235 μm. At month 5, 143 eyes (56%) were inactive defined by the absence of macular haemorrhage and intraretinal fluid (IRF) and subretinal fluid (SRF) on optical coherence tomography, and 112 eyes (44%) remained active. At month 11, 136 eyes (53%) were inactive, and 119 eyes (47%) remained active. At month 11, 77% of inactive eyes after loading remained inactive, and 77% of the active eyes after loading remained active. At month 11, mean BCVA of the inactive group was 0.51, and mean BCVA of the active group was 0.48 (P = 0.54). Conclusions Aflibercept administered by fixed dosing over 1 year improved VA and macular morphology in treatment-naïve eyes. Active lesions at month 11 do not have worse VA outcomes compared with inactive lesions. The macular status after loading is a reliable indicator of disease activity at the end of year 1.

New artery of knowledge: 3D models of angiogenesis

“…Targeting of vascular endothelial growth factor (VEGF) and VEGF receptors (using bevacizumab and aflibercept) (13,14,15), inhibition of EGF receptor and RAS-ERK pathway (using Tarceva and Cetuximab) (16) and PDGF receptor tyrosine kinases (using sunitinib) (17,18) are among the most promising therapeutic strategies. Moreover, anti-VEGF and PDGF therapies have been reported to effectively decrease angiogenesis in patients affected by age-related macular degeneration and diabetic retinopathy (14,19). However, despite the overall preclinical success of targeting VEGF or other angiogenic factors, it is unclear why some patients and several tissue types show resistance or only a limited or heterogeneous response to anti-VEGF compounds (20).…”

Our experience in visual functions' improvement in patiens with “wet” age-related macular degeneration at switching from one anti-VEGF agent to another

“…Интерпретацию полученных результатов может ограничивать то, что в данном исследовании был проведён анализ однократного ИВВ афлиберцепта и прослежена эффективность препарата в сроки менее одного года. Применение афлиберцепта согласно инструкции, что подразумевает проведение ИВВ 1 раз в 2 месяца после выполнения трёх ежемесячных загрузочных инъекций на первом году терапии, продемонстрировало значимое и устойчивое улучшение остроты зрения у пациентов как в клинических исследованиях VIEW, так и в реальной клинической практике [23][24][25][26].…”

Principles of anti-VEGF dosing in the treatment of neovascular age-related macular degeneration

“…1. Схема проведения терапии ингибиторами ангиогенеза в фиксированном режиме с ежемесячным выполнением интравитреальных инъекций (А) и с выполнением инъекций каждые 2 мес (Б) инъекций афлиберцепта 1 раз в 2 мес [15][16][17][18][19]. Режим с проведением инъекций ранибизумаба каждые 3 мес не нашел широкого распространения в связи с недостаточной эффективностью в отношении поддержания устойчивого улучшения зрения, что было показано в исследованиях PIER и EXCITE [20,21].…”