Anatomical and functional outcomes following switching from aflibercept to ranibizumab in neovascular age-related macular degeneration in Europe: SAFARI study

Gale, Richard; Pearce, Ian; Eter, Nicole; Ghanchi, Faruque; Holz, Frank G.; Schmitz-Valckenberg, Steffen; Balaskas, Konstantinos; Burton, Ben; Downes, Susan M.; Eleftheriadis, Haralabos; George, Sheena; Gilmour, David F.; Hamilton, Robin; Lotery, Andrew; Patel, Nirmal; Prakash, Priya; Santiago, Celine; Thomas, Sumi; Varma, Deepali; Walters, Gavin; Williams, Michael; Wolf, Armin; Zakri, Rosina; Igwe, Franklin; Ayan, Filis

doi:10.1136/bjophthalmol-2019-314251

Cited by 28 publications

(24 citation statements)

References 25 publications

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“…We found that switching from aflibercept to ranibizumab led to beneficial short-term results regarding retinal structure. Previous reports about switchback from aflibercept to ranibizumab have found similar results [18][19][20]. Compared with the monthly change before the switch, PED, IRF, and SRF showed significantly different, favorable changes postswitch.…”

Section: Discussionsupporting

confidence: 61%

“…Whether the effectiveness of this drug switch is attributable to a circumvention of drug tolerance or the different pharmacologic behaviors of the drugs has been speculated. However, there is little evidence about the effect of switching from aflibercept to ranibizumab [18][19][20]. Such evidence could help to elucidate the role of drug tolerance versus pharmacological differences.…”

Section: Introductionmentioning

confidence: 99%

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Beneficial switch from aflibercept to ranibizumab for the treatment of refractory neovascular age-related macular degeneration

Marquis

Mantel

2020

Graefes Arch Clin Exp Ophthalmol

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The aim of this study was to evaluate the effects of switching to ranibizumab in patients with neovascular age-related macular degeneration (nAMD) refractory to aflibercept treatment and to identify predictive factors for switch response. Methods A retrospective chart review was conducted including 32 eyes from 26 patients with refractory nAMD, who switched from monthly intravitreal aflibercept treatment (≥ 6 months) to ranibizumab. Outcome measures included changes in visual acuity (VA), intraretinal fluid (IRF), subretinal fluid (SRF), pigment epithelial detachment (PED), and central retinal thickness (CRT), evaluated at 6 months before switch (T1), at the time of switch (T2), and 3 months post-switch (T3). Results There was an increase in CRT from T1 to T2, which decreased after switch from T2 to T3. Regression analysis of the changes per month observed between time points showed significant differences in PED height (p = 0.02), SRF (p = 0.01), and neuroretinal thickness as a measure for IRF (p = 0.03). No significant change was found for VA. Predictive factors for better switch response included an exacerbation between T1 and T2, thicker measurements at T2, male sex, shorter treatment duration before switch, and fewer preceding injections. No association with preceding switch was found. Conclusion Patients with nAMD refractory to aflibercept benefit from switching to ranibizumab, particularly those whose condition worsened prior to the switch. This may be explained by drug tolerance to aflibercept. Our findings may facilitate making appropriate treatment decisions, potentially improving patient outcomes.

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Section: Discussionsupporting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Beneficial switch from aflibercept to ranibizumab for the treatment of refractory neovascular age-related macular degeneration

Marquis

Mantel

2020

Graefes Arch Clin Exp Ophthalmol

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“…Given the longstanding ocular history of exudative AMD in our cohort, underlying structural, in part irreversible damage may contribute to a limited potential of visual recovery. [29][30][31][32] The phenomenon of disconnect between morphology and function has been observed in other switch studies of patients with nAMD. [29][30][31][32] Since the approval of brolucizumab, safety signals of development of IOI following brolucizumab treatment, ranging from anterior chamber cells to retinal vasculitis with or without occlusion and with or without moderate and severe visual loss, have been reported.…”

Section: Clinical Sciencementioning

confidence: 62%

Short-term real-world outcomes following intravitreal brolucizumab for neovascular AMD: SHIFT study

et al. 2021

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BackgroundBrolucizumab has recently been approved in Europe as a novel treatment for patients with neovascular age-related macular degeneration (nAMD). We report on early experiences with real-world outcomes of switch to brolucizumab therapy in previously anti-vascular endothelial growth factor (anti-VEGF)-treated patients.MethodsPatients with recalcitrant nAMD were switched to brolucizumab therapy. Functional and structural parameters 4 weeks after first brolucizumab injection were evaluated including best-corrected visual acuity (BCVA (logMAR)), foveal centre point (FCP (µm)), central subfield retinal thickness (CSRT (µm)) and macular volume (mm³).ResultsSixty-three eyes of 57 patients with nAMD (52.6% females) with a mean (±SD) age of 79.5±6.7 years were included. Mean change of BCVA was −0.02±0.13 logMAR (p=0.322). Significant reductions were recorded for FCP with a mean (±SD) change of −66.79±72.64 µm, −66.76±60.71 µm for CSRT and −0.27±0.24 mm³ for macular volume (all p<0.001). Intraocular inflammation was observed in seven eyes of seven patients, including one case of retinal vasculitis without occlusion.ConclusionsThe results of the SHIFT study indicate that switch to brolucizumab may represent a treatment option in patients with nAMD poorly responsive to other anti-VEGF agents. Further long-term analyses appear prudent to assess efficacy and safety of brolucizumab in a routine clinical setting.

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“…A total of 100 eyes were included and nonsignificant improvements in mean macular thickness (−35.38 µm) and visual acuity (+1.9 letters) were noted at six months. In total, 34% of eyes were noted to have an increase of 5 or more letters after the switch in therapy [ 73 ]. Other smaller, retrospective studies have demonstrated similar benefits when switching to IVR in a subset of eyes with eAMD unresponsive to IVA [ 74 , 75 ].…”

Section: Exudative Age-related Macular Degenerationmentioning

confidence: 99%

Anti-VEGF-Resistant Retinal Diseases: A Review of the Latest Treatment Options

Wallsh

Gallemore

2021

Cells

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Anti-vascular endothelial growth factor (anti-VEGF) therapy currently plays a central role in the treatment of numerous retinal diseases, most notably exudative age-related macular degeneration (eAMD), diabetic retinopathy and retinal vein occlusions. While offering significant functional and anatomic benefits in most patients, there exists a subset of 15–40% of eyes that fail to respond or only partially respond. For these cases, various treatment options have been explored with a range of outcomes. These options include steroid injections, laser treatment (both thermal therapy for retinal vascular diseases and photodynamic therapy for eAMD), abbreviated anti-VEGF treatment intervals, switching anti-VEGF agents and topical medications. In this article, we review the effectiveness of these treatment options along with a discussion of the current research into future directions for anti-VEGF-resistant eyes.

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Anatomical and functional outcomes following switching from aflibercept to ranibizumab in neovascular age-related macular degeneration in Europe: SAFARI study

Cited by 28 publications

References 25 publications

Beneficial switch from aflibercept to ranibizumab for the treatment of refractory neovascular age-related macular degeneration

Beneficial switch from aflibercept to ranibizumab for the treatment of refractory neovascular age-related macular degeneration

Short-term real-world outcomes following intravitreal brolucizumab for neovascular AMD: SHIFT study

Anti-VEGF-Resistant Retinal Diseases: A Review of the Latest Treatment Options

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