Intravitreal Aflibercept for Patients With Diabetic Macular Edema Refractory to Bevacizumab or Ranibizumab: Analysis of Response to Aflibercept

Chen, Yen-Yi; Chang, Po‐Yuan; Wang, Jia-Kang

doi:10.22608/apo.2016186

Cited by 26 publications

(13 citation statements)

References 35 publications

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“…When treating DME with anti-VEGF agents, the physician has the option of trying other anti-VEGFs or corticosteroids in patients with poor response. Although there are no large randomized prospective clinical trials comparing treatment regimens for refractory DME, several smaller uncontrolled studies demonstrated visual and/or morphologic improvement after switching patients who showed poor response from aflibercept to ranibizumab injections [ 9 – 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Hence, it is logical to switch anti-VEGF agents between each other if the previous treatment is not sufficient to resolve macular edema. However, few studies have assessed the results of switching anti-VEGF therapies in patients with poor response to DME [ 9 – 12 ]. In light of these findings, there is still a question that remains to be answered regarding whether macular edema resolves when previous treatment is continued.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Intravitreal Aflibercept and Ranibizumab following Initial Treatment with Ranibizumab in Persistent Diabetic Macular Edema

Demircan

Alkın

Yeşilkaya

et al. 2018

Journal of Ophthalmology

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Purpose To compare the visual and anatomic outcomes in patients with persistent diabetic macular edema (DME) who switched from ranibizumab to aflibercept with those who continued with previous ranibizumab therapy. Methods In this retrospective comparative study, medical records of consecutive patients with center-involved DME ≥ 350 μm who had at least three recent consecutive monthly ranibizumab injections followed by as-needed therapy with either aflibercept or ranibizumab were reviewed. Data were collected at presentation (preinjection), at the intermediary visit, and at the last visit (at the end of the follow-up period). Results Forty-three eyes of 43 patients were divided into two groups: the switch group (n = 20) and the ranibizumab group (n = 23). Though no significant improvement was found in the mean BCVA from the intermediary visit to the last visit, there was a difference in the mean CMT in the switch group and the ranibizumab group (p < 0.001 and p = 0.03, resp.). The mean CMT decreased after the intermediary visit by 188.6 ± 120.5 μm in the switch group and by 60.3 ± 117.1 μm in the ranibizumab group (p = 0.003). Conclusions Both aflibercept and ranibizumab decreased CMT in patients with persistent DME who showed a poor response to ranibizumab injections. However, switching to aflibercept provided only morphologic improvement.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of Intravitreal Aflibercept and Ranibizumab following Initial Treatment with Ranibizumab in Persistent Diabetic Macular Edema

Demircan

Alkın

Yeşilkaya

et al. 2018

Journal of Ophthalmology

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“…There is ongoing debate about the definition of unsatisfactory treatment in DME. Some authors advocate that unsatisfactory response in DME is diagnosed when reduction of retinal thickness is suboptimal; others define it as inadequate visual improvement, while others may combine several parameters [1115]. Suboptimal response in DME could be attributed to many post ulated mechanisms such as tachyphylaxis [1617] or tolerance (due to receptor dysregulation or neutralizing antibody formation against the anti-VEGF agent) [181920].…”

Section: Discussionmentioning

confidence: 99%

“…A growing body of research is investigating different treatment protocols for management of resistant DME. Switching from bevacizumab or ranibizumab to aflibercept is one promising strategy for addressing this challenging situation [91011]. This positive effect could be explained by the different molecular structure [12], greater binding affinity [13], and/or longer intra-vitreal bio-availability of aflibercept [14].…”

mentioning

confidence: 99%

Switching to Aflibercept in Diabetic Macular Edema after Unsatisfactory Response to Other Anti-vascular Endothelial Growth Factor Drugs

Ibrahim

Eldaly

Saleh

et al. 2019

Korean J Ophthalmol

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Purpose To evaluate the efficacy of switching to aflibercept in diabetic macular edema (DME) with suboptimal response to previous anti-vascular endothelial growth factor (anti-VEGF) injections. Methods A prospective interventional case series study recruited patients from a single center diagnosed with DME with suboptimal response to anti-VEGF injections. Three consecutive monthly injections of aflibercept were performed. The primary outcome measure was mean change in visual acuity after switching to aflibercept. Results Forty-two patients (42 eyes) were included. Baseline logarithm of the minimum angle of resolution (logMAR) visual acuity was 0.87 ± 0.23 and improved significantly to 0.62 ± 0.29, 0.56 ± 0.34, and 0.46 ± 0.35 at 1, 2, and 3 months, respectively, after the first injection. Mean baseline retinal thickness was 451.57 ± 107.09 µm and decreased significantly at 1, 2, and 3 months after switching to aflibercept (346.52 ± 79.03, 328.24 ± 81.98, and 313.71 ± 85.79 µm, respectively). Both visual improvement and mean change in retinal thickness were significant in patients with pre-aflibercept best-corrected visual acuity less than 1.0 logMAR but were not significant in patients with best-corrected visual acuity more than 1.0 logMAR. Conclusions Switching to aflibercept in DME patients with an unsatisfactory response to previous anti-VEGF injections provided acceptable short-term visual and retinal architectural improvement.

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“…Chen et al prospectively evaluated the visual and anatomic outcomes of 72 eyes with DME refractory to bevacizumab or ranibizumab after switching to intravitreal aflibercept. 35 Three monthly doses of aflibercept were injected intravitreally. With an increase in the CST or visual gain of less than 1 line at 1 month following the conversion to aflibercept compared with before switching, the eye was considered a non-responder to aflibercept.…”

Section: Anti-vegf Switchingmentioning

confidence: 99%

Management of Refractory Diabetic Macular Edema: A Review Article

Torabi

2018

Int J Med Rev

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Diabetic retinopathy (DR) is a major cause of visual impairment worldwide. Visual reduction in patients with DR is usually related to diabetic macular edema (DME). Today, the intravitreal injection of anti-vascular endothelial growth factors (VEGF) is replacing macular laser photocoagulation as the standard treatment for DME; however, in some patients, incomplete responses to the anti-VEGF injection, defined as refractory DME, may occur. Currently, the sequence of using one treatment option and the timing to switch from one agent to another is not fully understood, and the data from clinical trials on the appropriate approach to manage refractory DME is insufficient. In the current study, a review was conducted to evaluate therapeutic options for the management of refractory DME.

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Intravitreal Aflibercept for Patients With Diabetic Macular Edema Refractory to Bevacizumab or Ranibizumab: Analysis of Response to Aflibercept

Abstract: Three monthly intravitreal aflibercept injections had benefit in nearly two thirds of cases with DME resistant to bevacizumab or ranibizumab over short-term follow-up. Vitrectomized eyes responded poorly to aflibercept treatment.

Cited by 26 publications

References 35 publications

Comparison of Intravitreal Aflibercept and Ranibizumab following Initial Treatment with Ranibizumab in Persistent Diabetic Macular Edema

Comparison of Intravitreal Aflibercept and Ranibizumab following Initial Treatment with Ranibizumab in Persistent Diabetic Macular Edema

Switching to Aflibercept in Diabetic Macular Edema after Unsatisfactory Response to Other Anti-vascular Endothelial Growth Factor Drugs

Management of Refractory Diabetic Macular Edema: A Review Article

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