Efficacy and Safety of Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy in the PLANET Study

Lee, Won Ki; Iida, Tomohiro; Ogura, Yuichiro; Chen, Shih‐Jen; Wong, Tien Yin; Mitchell, Paul; Cheung, Chui Ming Gemmy; Zhang, Zhongqi; Leal, Sérgio; Ishibashi, Tatsuro

doi:10.1001/jamaophthalmol.2018.1804

Cited by 224 publications

(263 citation statements)

References 27 publications

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“…The mean number of injections was 7.3 (EVEREST-II) and 8.1 (PLANET). 4,5 These results were corroborated further by the DRAGON study, 126 a phase 4 randomized, double-masked, multicenter trial based in China comparing the efficacy of IVT-R monotherapy using a monthly fixed dosing regimen versus a pro re nata regimen. 126 At baseline, 41.7% of the 334 enrolled patients were diagnosed with PCV based on ICGA results.…”

Section: Key Clinical Trialsmentioning

confidence: 79%

“…Recently, the first-year results of 2 major randomized trials have been released and have provided new evidence on optimal treatment for PCV: EVEREST-II compared intravitreal ranibizumab (IVT-R) monotherapy with combination therapy comprising IVT-R plus photodynamic therapy (PDT), whereas the PLANET study compared intravitreal aflibercept (IVT-AFL) monotherapy with or without rescue PDT. 4,5 The aim of this review was to summarize the latest evidence on the diagnosis and management of PCV, covering epidemiologic and risk factors, pathogenesis, definition and classification, and management options and to propose up-to-date management guidelines for clinicians managing patients with this condition.…”

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confidence: 99%

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Polypoidal Choroidal Vasculopathy

et al. 2018

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Polypoidal choroidal vasculopathy (PCV) is an age-related macular degeneration (AMD) subtype and is seen particularly in Asians. Previous studies have suggested disparity in response to intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents between PCV and typical AMD, and thus, the preferred treatment for PCV has remained unclear. Recent research has provided novel insights into the pathogenesis of PCV, and imaging studies based on OCT suggest that PCV belongs to a spectrum of conditions characterized by pachychoroid, in which disturbance in the choroidal circulation seems to be central to its pathogenesis. Advances in imaging, including enhanced depth imaging, swept-source OCT, en face OCT, and OCT angiography, have facilitated the diagnosis of PCV. Importantly, 2 large, multicenter randomized clinical trials evaluating the safety and efficacy of anti-VEGF monotherapy and combination with photodynamic therapy (PDT) recently reported initial first-year outcomes, providing level I evidence to guide clinicians in choosing the most appropriate therapy for PCV. In this review, we summarize the latest updates in the epidemiologic features, pathogenesis, and advances in imaging and treatment trials, with a focus on the most recent key clinical trials. Finally, we propose current management guidelines and recommendations to help clinicians manage patients with PCV. Remaining gaps in current understanding of PCV, such as significance of polyp closure, high recurrence rate, and heterogeneity within PCV, are highlighted where further research is needed.

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Section: Key Clinical Trialsmentioning

confidence: 79%

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confidence: 99%

Polypoidal Choroidal Vasculopathy

et al. 2018

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“…The EVEREST II study found that combination therapy of full-dose PDT and intravitreal injections of ranibizumab was superior to monotherapy consisting of intravitreal injections of ranibizumab, in terms of BCVA and complete polyp regression [40]. However, recent studies suggest that anti-VEGF monotherapy with, for example, aflibercept has similar efficacy, at least in an Asian population [41,42].…”

Section: Specific Considerations When Treating Polypoidal Choroidal Vmentioning

confidence: 99%

Photodynamic Therapy for Chorioretinal Diseases: A Practical Approach

et al. 2020

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Photodynamic therapy (PDT) using verteporfin (VisudyneÒ; Bausch ? Lomb) is a treatment that is widely used to elicit cell and tissue death. In ophthalmology, PDT targets choroidal vascular abnormalities and induces selective occlusion of vessels. PDT was originally used in combination with full-dose verteporfin to treat neovascular age-related macular degeneration.Since the introduction of treatment with vascular endothelial growth factor receptor inhibitors, the clinical targets of PDT have shifted to other chorioretinal conditions, such as central serous chorioretinopathy, polypoidal choroidal vasculopathy, and choroidal hemangioma. In recent years, clinical studies have facilitated the optimization of treatment outcomes through changes in protocols, including the introduction of reduced treatment settings, such as PDT with half-dose verteporfin and half-fluence PDT. Here, we review PDT and its use for chorioretinal diseases from a practical perspective.Patients should be adequately informed to avoid direct sunlight after treatment, and side effects during and after PDT are rare.

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“…Treatments may include thermal laser (reserved for extrafoveal polyps), photodynamic therapy (PDT) and anti‐vascular endothelial growth factor (anti‐VEGF) injections . Combination therapy with anti‐VEGF and PDT has been evaluated in the recently published randomized controlled trials EVEREST II and PLANET studies, respectively . Surgery is generally reserved for complicated cases, and in particular, subretinal with or without vitreous haemorrhage.…”

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confidence: 99%

“…EVEREST II suggested that ranibizumab combined with PDT offered superior visual outcomes than anti‐VEGF monotherapy by around three ETDRS letters, required fewer injections (four vs seven), and had double the polyp closure rate (70% vs. 35%) at 12 months . PLANET reported that aflibercept monotherapy was a suitable treatment of PCV (85% of patients were dry and inactive at 1 year) and most cases demonstrated a prompt and significant clinical benefit, with few patients (<15%) requiring rescue PDT . Three cases of vitreous haemorrhage were reported in EVEREST II from 322 eyes (two in the monotherapy arm and one in the combination arm), but it is not clear if this was related to submacular haemorrhage and breakthrough or some other cause .…”

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confidence: 99%