Response to Bevacizumab after Treatment with Aflibercept in Eyes with Neovascular AMD

Waizel, Maria della Volpe; Rickmann, Annekatrin; Blanke, Björn R.; Wolf, Katharina; Kazerounian, Sara; Szurman, Peter

doi:10.5301/ejo.5000781

Cited by 10 publications

(9 citation statements)

References 12 publications

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“…In our study, some of the effect may also be a result of tachyphylaxis to RBZ and the subsequent benefit of switching anti-VEGF agents. It is unclear whether a change to another anti-VEGF agent such as bevacizumab would also have resulted in similar short term improvements as has been reported elsewhere [ 28 ]. Tachyphylaxis to AFL treatment may also explain the progressive worsening of visual acuity and CRT following longer term treatment with AFL in stage 4 [ 29 ].…”

Section: Discussionmentioning

confidence: 91%

Clinical outcomes of switching to aflibercept using a pro re nata treatment regimen in patients with neovascular age-related macular degeneration who incompletely responded to ranibizumab

et al. 2018

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BackgroundTo assess the effect of switching patients previously incompletely treated with ranibizumab (RBZ) to aflibercept (AFL) using a pro re nata (PRN) treatment strategy in neovascular age-related macular degeneration (nvAMD).MethodsA retrospective case series was conducted on patients who had persistent or recurrent intra- and/or sub-retinal fluid treated initially with RBZ and subsequently switched to AFL. The main outcome measures were best corrected visual acuity (BCVA) and central retinal thickness (CRT) measured at different stages of the study. Friedman analysis of variance and Wilcoxon test were used to examine differences in BCVA and CRT.ResultsTwo hundred and seven eyes from 182 patients were included. BCVA and CRT improved significantly initially following 3 RBZ injections with a mean gain of 3.7 letters (p < 0.001) and a mean loss of 69 μm (p < 0.001) respectively. Following PRN RBZ therapy and immediately prior to switching to AFL (mean 129 weeks), there was a mean loss of 6.7 letters (p < 0.001) BCVA and a mean gain of 24 μm (p < 0.001) CRT.AFL loading resulted in a mean improvement of 0.7 letters (p = 0.28) BCVA and 55 μm (p < 0.001) CRT. At final follow-up following AFL PRN therapy (mean 85 weeks), there was a mean loss of 8.9 letters (p < 0.001) BCVA and a mean gain of 12 μm (p < 0.05) CRT.ConclusionAFL loading resulted in a significant anatomical improvement but no significant change in visual acuity. However, the benefits of switching were gradually lost over time with AFL PRN dosing despite an increased injection rate when compared with RBZ PRN treatment.Trial registrationNot applicableElectronic supplementary materialThe online version of this article (10.1186/s12886-018-0688-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 91%

Clinical outcomes of switching to aflibercept using a pro re nata treatment regimen in patients with neovascular age-related macular degeneration who incompletely responded to ranibizumab

et al. 2018

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“…In 19 eyes of both responders and non-responders, an average increase from Snellen 0.18 to 0.20 was seen after 7.2 months. 22…”

Section: Discussionmentioning

confidence: 99%

Worth changing? Clinical effects of switching treatment in neovascular age-related macular degeneration from intravitreal ranibizumab and aflibercept to bevacizumab in a region in southern Sweden

Bro¹,

Hägg

2019

European Journal of Ophthalmology

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Purpose: To examine the clinical effects of switching intravitreal drug treatment from the approved vascular endothelial growth factor inhibitors, ranibizumab and aflibercept, to off label use of bevacizumab in patients with wet age-related macular degeneration. Methods: This retrospective study scrutinized medical records of patients with wet age-related macular degeneration who switched therapy to bevacizumab due to a policy decision. Best corrected visual acuity, central retinal thickness, and number of injections before and 1 year after the switch was compared. The non-inferiority margin of best corrected visual acuity was five Early Treatment Diabetic Retinopathy Study letters. Results: A switch from ranibizumab was evaluable in 93 eyes and from aflibercept in 19 eyes. Neither of the groups had a significant non-inferior visual acuity 16 month after the switch. Mean best corrected visual acuity in Early Treatment Diabetic Retinopathy Study letters was 63.8 (95% confidence interval: 61.3–66.4) before and 62.2 (95% confidence interval: 59.3–65.1) after in the ranibizumab group and 68.2 (95% confidence interval: 63.3–73.1) before and 67.7 (95% confidence interval: 62.8–72.6) after in the aflibercept group. Mean central retinal thickness in micrometers decreased from 254 (95% confidence interval: 247–261) to 250 (95% confidence interval: 225–275) in the ranibizumab group and from 265 (95% confidence interval: 255–276) to 262 (95% confidence interval: 251–273) in the aflibercept group. The treatment was changed again after the switch in 18% of the patients in the ranibizumab group and 19% in the aflibercept group and these subjects were excluded from the analyses. Conclusion: In patients with neovascular age-related macular degeneration, a switch from ranibizumab or aflibercept to bevacizumab seems possible without a significant decrease in visual acuity in most patients.

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“…As we presented a retrospective, observational study, it was not always possible to reconstruct the anatomic type of neovascular maculopathy. Thus, as mentioned in the article (1), a prospective, randomized trial with a larger number of patients included is needed to prove our preliminary results.…”

mentioning

confidence: 84%

“…We thank Drs. Călugăru and Călugăru for their interest in our study (1), which presented the visual outcome and change in CMT in patients with neovascular AMD who were previously treated with aflibercept (vascular endothelial growth factor [VEGF] Trap-Eye, Eylea) and were subsequently switched to bevacizumab (Avastin). We would like to respond to the questions that were raised regarding our article:…”

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confidence: 99%

Author'S Reply to Comments To: Response to Bevacizumab after Treatment with Aflibercept in Eyes with Neovascular AMD

Waizel

Kazerounian

Rickmann

et al. 2016

European Journal of Ophthalmology

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Response to Bevacizumab after Treatment with Aflibercept in Eyes with Neovascular AMD

Cited by 10 publications

References 12 publications

Clinical outcomes of switching to aflibercept using a pro re nata treatment regimen in patients with neovascular age-related macular degeneration who incompletely responded to ranibizumab

Clinical outcomes of switching to aflibercept using a pro re nata treatment regimen in patients with neovascular age-related macular degeneration who incompletely responded to ranibizumab

Worth changing? Clinical effects of switching treatment in neovascular age-related macular degeneration from intravitreal ranibizumab and aflibercept to bevacizumab in a region in southern Sweden

Author'S Reply to Comments To: Response to Bevacizumab after Treatment with Aflibercept in Eyes with Neovascular AMD

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