Intravitreal Aflibercept for Macular Edema Secondary to Central Retinal Vein Occlusion: 18-Month Results of the Phase 3 GALILEO Study

Comment on ‘The Royal College of Ophthalmologists Guidelines on retinal vein occlusions: executive summary’

“…We read with great interest the legitimate and comprehensive guidelines on retinal vein occlusions (RVO) elaborated by Sivaprasad et al 1 However, the reference data were not updated with the available long-term results of the trials, which had dealt with the efficacy of therapy with ranibizumab (Lucentis, Genentech, Inc., South San Francisco, CA, USA) and aflibercept (Eylea, Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA) for macular edema secondary to central RVO (CRVO). [2][3][4] Specifically, the rates of unresolved macular edema were 56% in the RETAIN study, 2 65.7% in the COPERNICUS study, 3 and 39.4% in the GALILEO study, 4 after 51.4, 24, and 18 months of follow-up, respectively. Delayed deterioration in the outcome measures in the mentioned trials could be explained by the lower frequency of injections as well as the long duration of time from CRVO diagnosis to initiation of treatment, during which time patients went without treatment for example, an average of 6.39, 2.73, and 2.6 months in the RETAIN, 2 COPERNICUS, 3 and GALILEO 4 trials, respectively.…”

“…NICE TA238 refers to the use of tocilizumab for the treatment of systemic juvenile idiopathic arthritis. 4 This should be replaced by NICE TA283, which refers to the use of ranibizumab for treating visual impairment caused by macular oedema secondary to RVO. 2 In summary, I would like to thank and congratulate the authors on updating the RVO guidelines with the most current evidence, which helps to streamline the current practice in the UK and ultimately benefits the patients whom we are treating.…”

Patterns of ranibizumab and aflibercept treatment of central retinal vein occlusion in routine clinical practice in the USA

“…The Lotery and Regnier results 1 exhibited that in routine clinical practice in the USA, the number of injections was too small (approximately half of the standard claimed by the clinical trials), [2][3][4] and the interval between injections was too long. For this reason, we concluded that in the real world, CRVO patients had been insufficiently treated in a period of time in which the amount of vascular endothelial growth factor had been upregulated, which adversely influenced the final restoration of visual function.…”

“…5 Of note, PRN treatment undertaken after the first 12 months of aggressive treatment does not prevent the delayed occurrence of deterioration in visual acuity and foveal thickness, which has been reported by all the clinical trials. [2][3][4] Sir, Response to 'Patterns of ranibizumab and aflibercept treatment of central retinal vein occlusion in routine clinical practice in the USA'…”

Extended release anti-VEGF systems: a strategy whose time has come? Or already gone?

“…The widespread use of drugs that inhibit the actions of vascular endothelial growth factor (VEGF) has helped millions of patients throughout the world by significantly decreasing vision loss due to neovascular age-related macular degeneration (nAMD) [1][2][3], diabetic macular edema (DME) [4][5][6], and edema due to retinal vein occlusion (RVO) [7,8]. Monthly injections of anti-VEGF drugs as given in the phase III registration trials not only prevent significant vision loss (≥15 Early Treatment Diabetic Retinopathy Study letters) in 95% of eyes, but they produce 1-year mean improvements in best corrected visual acuity (BCVA) of +7 to +12 letters in eyes with nAMD and DME, and +16 to +18 letters in eyes with RVO.…”