High-Dose High-Frequency Aflibercept for Recalcitrant Neovascular Age-Related Macular Degeneration

Abstract

This retrospective study demonstrated 4 mg monthly aflibercept is effective in treating recalcitrant neovascular age-related macular degeneration. Sustainable significant anatomical improvement was shown starting 1 month after initiating the treatment, and 45% of the treated eyes showed vision improvement of 1 line or more at the last visit.

Durability of every-8-week aflibercept maintenance therapy in treatment-experienced neovascular age-related macular degeneration

“…Our PRN treatment regimen is similar to that of the Comparison of AMD Treatments Trials (CATT) and it allows determination of durability of treatment as well as disease reactivation intervals. In our experience, eyes which responded poorly to first line agents at least initially responded well to aflibercept [2][3][4]. Previously, we have used aflibercept every-8-weeks in eyes which responded, although incompletely, to other agents.…”

“…We previously reported our standard protocol for the treatment of neovascular AMD [2][3][4]11]. A fixed regimen of strict monthly bevacizumab (Avastin , Genentech, San Francisco, CA, USA) or ranibizumab (Lucentis, Genentech, San Francisco, CA, USA) intravitreal injections was started until the retina becomes completely dry, after which 1 to 2 bonus injections were given before going to an observation phase.…”

“…Patients who developed treatment resistance to either bevacizumab or ranibizumab were switched to aflibercept (Regeneron, Tarrytown, NY, USA) injections on PRN basis since 2012, when aflibercept became available [2][3][4]11]. Treatment resistance was defined as having multiple recurrences (minimum of 2 recurrences after the eyes have been completely dry following a series of at least 3 monthly injections per treatment cycle) or persistence of exudation (poor response to monthly ranibizumab or bevacizumab for at least 5 months) as evident on clinical examination and on imaging studies (leakage on FA, or fibrovascular PED with IRF or SRF on SD-OCT) while on monthly ranibizumab or bevacizumab monotherapy.…”

“…Its approval for use in AMD is every eight weeks after a series of three injections given every four weeks as part of an induction regimen [1]. Our prior experience with aflibercept has been published using it as a second line drug if bevacizumab or ranibizumab either became ineffective or require multiple retreatment courses due to reactivations after discontinuing therapy using a pro re nata (PRN) treatment regimen [2]. Our PRN treatment regimen is similar to that of the Comparison of AMD Treatments Trials (CATT) and it allows determination of durability of treatment as well as disease reactivation intervals.…”

Reply

“…Călugăru 1 for their interest in our study “High dose high frequency aflibercept for recalcitrant neovascular age-related macular degeneration”. 2 We addressed the points raised as following.…”