Non-responders to treatment with antagonists of vascular endothelial growth factor in age-related macular degeneration

Defining response to anti-VEGF therapies in neovascular AMD

“…However, this initial response at month 4 is not always predictive of long-term VA gains, as a proportion of such eyes continue to accrue gains in vision even after month 4 as in the ANCHOR and MARINA studies, 22,24 HARBOR study 30 and subsequent case series. 31 Furthermore, the PIER, 32 SUSTAIN 27 and EXCITE 33 studies suggested response to treatment may not always reflect the visual outcome after the initiation (loading) initiation phase.…”

The non-Responsiveness to Anti-Vascular Endothelial Growth Factor Agents in the Treatment of Neovascularage-Related Macular Degeneration

“…However, some patients cannot respond to the treatment as expected. In recent studies, it has been showed that the incidence for non responsiveness to bevacizumab in treatment naïve n-AMD ranges between approximately 40 and 50% while as the percent of non responsiveness to ranibizumab was between approximately 10-20% [6][7][8][9]. Although there is currently no more evidence in the literature, a recent report demonstrated that the rates of non responsiveness to aflibercept in the treatment of n AMD based on best corrected visual acuity (BVCA) and fundus findings were approximately 8% and 13%, respectively [10].…”

“…However, non responsiveness is exactly different from above mentioned most nomenclatures. If the mistaken diagnosis, tachyphylaxis, and complications secondary to the drug's itself or its application were excluded, the non responsiveness to intravitreal anti-VEGF injection in the treatment of n-AMD is defined as the loss (more than 0.2 or 5 letters) or no change in BVCA compared to baseline with persistent macular hemorrhage in fundus examination, intraretinal or subretinal fluid on optical coherence tomography and the leakage in fluorescein angiography despite to a protocol including 3 or 6 consecutive monthly intravitreal anti-VEGF injections [6][7][8][9][10][11][12]. However, there is no consensus on the defining of the non responsiveness.…”

“…In the light of the recent reports, it can be considered that the potential risk factors for non-responsiveness to anti-VEGF agent in the treatment of n-AMD are an initial lesion with subfoveal fibrosis or atrophy in retina pigment epithelium and photoreceptors, lesion in large size, type 1 choroidal neovascularization, serous pigment epithelium detachment (PED), haemorrhagic PED, fibrovascular PED, polypoidal choroidal vasculopathy, foveal scarring and vitreomacular traction, outer retinal tubulation, cystoid degeneration in outer retina, genetic disposition or an anti-VEGF resistance [Table 1, 13-22]. Table 1: The possible risk factors for non-responsiveness to anti-VEGF agents in the patients with nAMD [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22].…”

Economic analysis of aflibercept in wet age-related macular degeneration

“…Так, при использовании РБЗ необхо-дим ежемесячный осмотр [4]. Вдобавок у части па-циентов с вВМД отмечается резистентность к РБЗ [6]. Афлиберцепт (АФЛ) -новый ИА, предназна-ченный для лечения вВМД.…”