Clinical response of pigment epithelial detachment associated with neovascular age-related macular degeneration in switching treatment from Ranibizumab to Aflibercept

Tyagi, Pallavi; Juma, Zain; Hor, Yong Keen; Scott, Neil; Ionean, Andreea; Santiago, Celine

doi:10.1186/s12886-018-0824-0

Cited by 13 publications

(12 citation statements)

References 28 publications

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“…We further analysed patients unresponsive to ranibizumab with a therapy switch to aflibercept. In accordance to the literature (26)(27)(28)(29)(30)(31), our results show a benefit of a therapy switch to aflibercept for patients' refractory to ranibizumab. Only one study showed visual acuity improvement after aflibercept injection according to a fixed regimen (28).…”

Section: Discussionsupporting

confidence: 92%

Comparison of the therapy effect of aflibercept and ranibizumab in patients with neovascular retinal pigment epithelium detachment identified by fluorescence angiography and optical coherence tomography angiography

Ruebsam¹,

Dominika²,

Tina³

et al. 2019

Preprint

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Background To report on the current methods for choroidal neovascularization (CNV) detection and the clinical outcome of intravitreal therapies in patients with neovascular pigment epithelium detachment (PED). Methods Retrospective, interventional cohort study on 77 eyes of 59 patients. Inclusion criteria were a neovascular PED, identified by fluorescence angiography (FA) or/and optical coherence tomography angiography (OCTA) treated with aflibercept (16 eyes) or ranibizumab monotherapy (36 eyes) or with at least three injections of ranibizumab, with a therapy switch to aflibercept in case of persistent fluid (25 eyes). The therapy regimen was a pro re nata (PRN) scheme with an upload phase of three monthly injections. Outcome measures were sensitivity of CNV detection and evaluation of CNV activity at baseline on FA compared to OCTA, the change in highest retinal prominence (HRP) and PED size, assessed by spectral - domain OCT (SD-OCT), and the change in best-corrected visual acuity (BCVA) three months after therapy initiation in the monotherapy groups or after the switch. Results Sensitivity of CNV detection was slightly superior for FA (0.786) compared to OCTA (0.706), whereas CNV activity evaluation was superior on OCTA. HRP significantly decreased after aflibercept (p<0.001) or ranibizumab monotherapy (p<0.001), and after therapy switch to aflibercept (p<0.001) in ranibizumab refractory patients. Corresponding BCVA improved in these groups, but without statistical significance (p=0.46; p = 0.11; p=0.19). PED size significantly decreased after aflibercept monotherapy (p=0.001) or after therapy switch to aflibercept (p<0.001), but not after ranibizumab. Conclusions The combination of FA and OCTA offers significantly improved visualisation, quantification, and predictability of CNV activity in neovascular PED. Aflibercept and ranibizumab are effective treatment options for neovascular AMD with PED, with a stronger effect of aflibercept on the PED itself. Furthermore, aflibercept appears to be a valuable tool for the management of patients unresponsive to ranibizumab.

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Section: Discussionsupporting

confidence: 92%

Comparison of the therapy effect of aflibercept and ranibizumab in patients with neovascular retinal pigment epithelium detachment identified by fluorescence angiography and optical coherence tomography angiography

Ruebsam¹,

Dominika²,

Tina³

et al. 2019

Preprint

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“…However, despite the anatomical improvement, there was no significant change in visual function. [ 18 19 ] Hypothetically, a higher penetration of aflibercept (or ziv-aflibercept in this series) in sub-RPE space is a possibility, however, this has not been proven conclusively in the past.…”

Section: Discussionmentioning

confidence: 82%

Regression in polypoidal choroidal vasculopathy treated with ziv-aflibercept monotherapy – short term study

Chhablani

Mishra

Singh

et al. 2021

Saudi Journal of Ophthalmology

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PURPOSE: The aim of this study was to evaluate the effectiveness of intravitreal ziv-aflibercept (IVZ) in the treatment of polypoidal choroidal vasculopathy (PCV) and its efficacy in regard to polyp regression using optical coherence tomography (OCT) and indocyanine green angiography (ICGA). METHODS: This was a retrospective study of eight eyes of eight patients with treatment-naïve PCV. Patients received IVZ on pro re nata protocol. OCT and ICGA parameters were assessed at baseline and subsequent visits with a minimum follow-up of 6 months. ICGA was repeated at 3–6 months to determine the disease activity and quantify the changes in branching vascular network (BVN) polyps. Quantifiable OCT parameters included central macular thickness, pigment epithelial detachment (PED) height, and subfoveal choroidal thickness. RESULTS: The mean age of the study cohort was 62.3 ± 7.7 years, with a mean follow-up of 7.1 ± 1.2 months. The baseline best-corrected visual acuity improved from 0.70 ± 0.36 logarithm of the minimum angle of resolution (Snellen's equivalent 20/100) to 0.63 ± 0.34 (20/80) at last follow-up which was statistically insignificant ( P = 0.5). Post IVZ injections (mean ± standard deviation: 2.6 ± 0.7), the total number of polyps reduced significantly from 3 ± 3.5 to 1 ± 1.7 ( P = 0.03) along with a reduction in BVN size (3.9 ± 4.8 to 2.7 ± 3.8mm 2 ; P = 0.07). OCT analysis revealed a significant reduction in PED height from 462.5 ± 353.8 μ to 169.9 ± 127.2 μ ( P = 0.02). CONCLUSION: IVZ leads to significant morphological changes on ICGA and OCT in terms of polyp regression and reduction of PED height, respectively, with a limited change in visual acuity. IVZ may serve as a cost-effective alternative to treat eyes with PCV.

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“…Twelve months after switching to aflibercept, the BCVA did not change (from 63.7 to 63.3 ETDRS letters), although the CST was significantly reduced from 271 to 242 μm ( p < 0.001) [54]. Moreover, a non-significant VA change without any CRT data was reported by Kanesa-Thasan et al [55], Barthelmes et al [56] and Tyagi et al [57].…”

Section: Resultsmentioning

confidence: 96%

“…In contrast, Kim et al [31] reported a stable PED volume 12 months after conversion to aflibercept in cases with refractory PED. Tyagi et al [57] found a significant reduction in PED height but not PED width in 50 cases, 12 months after switching from ranibizumab to aflibercept.…”

Section: Resultsmentioning

confidence: 99%

How Successful is Switching from Bevacizumab or Ranibizumab to Aflibercept in Age-Related Macular Degeneration? A Systematic Overview

et al. 2019

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Emerging anti-vascular endothelial growth factor (anti-VEGF) therapies for neovascular agerelated macular degeneration (nAMD) have revolutionised medical retina practice and the management and eventual outcome of nAMD. Recent research has focused on evaluating and comparing the efficacy of the two most widely employed anti-VEGF agents, bevacizumab and ranibizumab; however, a subgroup of patients with nAMD demonstrates a suboptimal response to standard therapy. We have therefore conducted a review of pertinent studies published until August 2018 which have documented the clinical efficacy when switching to a different anti-VEGF. Evidence on baseline disease characteristics, injection frequency and disease outcome has been obtained for patients treated with ranibizumab 0.5 mg and/or bevacizumab 1.25 mg and were switched to aflibercept 2 mg. Our review identified 45 studies investigating switching to aflibercept. Our review showed a clear anatomical benefit after the switch in terms of central retinal thickness and pigment epithelium detachment characteristics, whereas the functional outcomes were variable. Remarkable heterogeneity was documented among the relevant studies with regard to several factors including the baseline characteristics of the cohorts, the non-response definition and previous treatment protocols. Larger prospective trials with appropriate control arms are therefore required to elucidate the potential benefit when switching between anti-VEGF agents in refractory nAMD.

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Clinical response of pigment epithelial detachment associated with neovascular age-related macular degeneration in switching treatment from Ranibizumab to Aflibercept

Cited by 13 publications

References 28 publications

Comparison of the therapy effect of aflibercept and ranibizumab in patients with neovascular retinal pigment epithelium detachment identified by fluorescence angiography and optical coherence tomography angiography

Comparison of the therapy effect of aflibercept and ranibizumab in patients with neovascular retinal pigment epithelium detachment identified by fluorescence angiography and optical coherence tomography angiography

Regression in polypoidal choroidal vasculopathy treated with ziv-aflibercept monotherapy – short term study

How Successful is Switching from Bevacizumab or Ranibizumab to Aflibercept in Age-Related Macular Degeneration? A Systematic Overview

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