Short-term results of early switch from Ranibizumab to Aflibercept in poor or non responder age related macular degeneration in clinical practice

Quirino-Makarczyk, Luciana de Sá; Ugarte, Maria de Fátima Sainz; Vieira, Bruna Viana; Kniggendorf, Sergio L.; Regatieri, Caio V.

doi:10.1186/s40942-020-00212-5

Cited by 4 publications

(3 citation statements)

References 30 publications

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“…In another retrospective study, when non-responders or poor responders to three monthly IVR were then treated with three monthly IVA, there was a significant anatomic improvement in CSFT, but no significant change in visual acuity, comparable to the results in our study. 15 Despreaux et al 16 showed that in nAMD patients previously switched from IVR to IVA, a ‘switchback’ of IVA to IVR resulted in a short-term benefit in terms of both CSFT and BCVA.…”

Section: Discussionmentioning

confidence: 99%

Brolucizumab for persistent macular fluid in neovascular age-related macular degeneration after prior anti-VEGF treatments

Hussain

Neal²,

Yannuzzi

et al. 2021

Ophthalmol Eye Dis

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Background: Some patients with neovascular age-related macular degeneration (nAMD) have persistent intraretinal/subretinal fluid (IRF/SRF) despite being treated with anti-VEGF agents. There is limited data on efficacy of switching to intravitreal brolucizumab (IVBr) in these patients. Purpose: To determine anatomic and visual outcomes of eyes with nAMD treated with for persistent IRF/SRF. Methods: Retrospective series of eyes with nAMD treated initially with aflibercept (IVA, n = 48) and bevacizumab (IVBe, n = 10), then switched to IVBr for persistent IRF/SRF. Results: In the IVA-IVBr group, a mean of 42 days after one IVBr, mean logMAR changed from 0.50 to 0.49 ( p = 0.73) and mean CSFT changed from 340 to 305 µm ( p < 0.001); 31% of eyes had no fluid, 42% had persistent but reduced fluid, 25% had stable fluid, and 2% had increased fluid. For a subgroup of 25 eyes that completed a series of 3 IVBr, mean logMAR changed from 0.44 to 0.40 ( p = 0.35) and mean CSFT changed from 325 to 277 µm ( p = 0.001); 24% of eyes had no fluid at last follow-up, a mean of 54 days after last IVBr. In the IVBe-IVBr group, a mean of 44 days after one IVBr, mean logMAR changed from 0.46 to 0.40 ( p = 0.114) and mean CSFT from 401 to 325 µm ( p = 0.009); 30% of eyes had no fluid and 70% had persistent but reduced fluid. For a subgroup of four eyes that completed a series of three IVBr, mean logMAR changed from 0.33 to 0.35 ( p = 0.391) and mean CSFT improved from 375 to 275 µm ( p = 0.001); 50% of eyes had no fluid at last follow-up, a mean of 65 days after last IVBr. Conclusion: In nAMD eyes previously treated with IVA and IVBe, switching to IVBr significantly reduced persistent IRF/SRF but did not significantly affect visual outcomes.

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Section: Discussionmentioning

confidence: 99%

Brolucizumab for persistent macular fluid in neovascular age-related macular degeneration after prior anti-VEGF treatments

Hussain

Neal²,

Yannuzzi

et al. 2021

Ophthalmol Eye Dis

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“…Although outside of the scope of the current study, it would be important to test the effectiveness of ultrasound in enhancing delivery of a range of macromolecules used in the treatment of retinopathies, including direct comparison of bevacizumab (Avastin) with a molecular weight of 149 kDa with ranibizumab and aflibercept, which have molecular weights of 48 and 115 kDa, respectively. 34 , 74 Modeling of ultrasound application in a pulsed and continuous mode would allow for further understanding of the thermal changes in different eye tissues during ultrasound application. In future studies, we plan to test this technology in long-term animal studies in vivo and in subsequent clinical trials.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of Therapeutic Ultrasound Application in Topical Scleral Delivery of Avastin

Almogbil

Nasrallah

Zderic

2021

Trans. Vis. Sci. Tech.

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Purpose Macromolecules have been shown to be effective in vision-saving treatments for various ocular diseases, such as age-related macular degeneration and diabetic retinopathy. The current delivery of macromolecules requires frequent intraocular injections and carries a risk of serious adverse effects. Methods We tested the application of therapeutic ultrasound as a minimally invasive approach for the delivery of Avastin into the diseased regions of the eye. Avastin (bevacizumab) is an anti-vascular endothelial growth factor (VEGF) antibody with a molecular weight of 149 kDa. We tested the effectiveness and safety of Avastin delivery through rabbit sclera in vitro using a standard diffusion cell model. Ultrasound at frequencies of 400 kHz or 3 MHz with an intensity of 1 W/cm 2 was applied for the first 5 minutes of 1-hour drug exposure. Sham treatments mimicked the ultrasound treatments, but ultrasound was not turned on. Absorbance measurements of the receiver compartment solution were performed at 280 nm using a spectrophotometer. Results Absorbance measurements indicated no statistical difference between the sham ( n = 13) and 400 kHz ultrasound group ( n = 15) in the delivery of Avastin through the sclera. However, the absorbance values were statistically different ( P < 0.01) between the 3 MHz ultrasound group (0.004, n = 8) and the matched sham group (0.002, n = 7). There was 2.3 times increase in drug delivery in the 3 MHz ultrasound when compared to the corresponding sham group. Histological studies indicated no significant damage in the ultrasound-treated sclera due to ultrasound application. Conclusions Our preliminary results provided support that therapeutic ultrasound may be effective in the delivery of Avastin through the sclera. Translational Relevance Our study offers clinical potential for a minimally invasive retinopathy treatment.

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“…There are more reports in the literature about switching from ranibizumab to aflibercept, or from bevacizumab to aflibercept or ranibizumab than the other way around [7][8][9][10][11]. The results of these studies vary: some show the effectiveness of the switch in the form of anatomical improvement (CRT) and functional improvement (BCVA) [7,9,10]; others show anatomical improvement, but no changes in BCVA [8,10,11]. The SAFARI study, in which the authors assessed the effectiveness of the switch from aflibercept to ranibizumab, showed greater anatomical than functional improvement in the studied patients [12].…”

Section: Discussionmentioning

confidence: 99%

Switching Between Aflibercept and Ranibizumab in the Treatment of Refractory Exudative Age-related Macular Degeneration

2021

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Introduction: Aflibercept and ranibizumab have become the most used drugs in the treatment of wet age-related macular degeneration. Some patients; however, do not respond to aflibercept and ranibizumab treatment. Our aim was to determine whether the switch from aflibercept to ranibizumab, and then switchback, is effective in a group of patients poorly responding to aflibercept. We assessed best corrected visual acuity, central retinal thickness, and the presence of intra- and subretinal fluid (respectively). Material and methods: We conducted a retrospective comparative case series study. Twenty eyes of 20 patients, who had no inhibition of disease activity after at least one year of treatment with aflibercept, were included in the study. If after switch to ranibizumab the response to the drug was again inadequate, we returned to aflibercept. We divided the study population into two groups: treatment- naïve and patients who had received injections before entering the Drug Program for the Treatment of Age-Related Exudative Macular Degeneration. Results: We observed an improvement in both best corrected visual acuity and central retinal thickness parameters, but only in the treatment-naïve group. We did not observe any statistically credible effects for sub- and intraretinal fluid in the studied groups. Conclusions: Drug conversion may be beneficial for patients poorly responding to primary therapy. Greater improvement is seen in previously untreated patients.

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Short-term results of early switch from Ranibizumab to Aflibercept in poor or non responder age related macular degeneration in clinical practice

Cited by 4 publications

References 30 publications

Brolucizumab for persistent macular fluid in neovascular age-related macular degeneration after prior anti-VEGF treatments

Brolucizumab for persistent macular fluid in neovascular age-related macular degeneration after prior anti-VEGF treatments

Feasibility of Therapeutic Ultrasound Application in Topical Scleral Delivery of Avastin

Switching Between Aflibercept and Ranibizumab in the Treatment of Refractory Exudative Age-related Macular Degeneration

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