Real-World Results of Aflibercept versus Ranibizumab for the Treatment of Exudative AMD Using a Fixed Regimen

Abstract

Intravitreal injections of antivascular endothelial growth factors have been considered a milestone in the treatment of neovascular age-related macular degeneration (nAMD). However, the increasing incidence of AMD and the burden of visits and injections overcharge both the patient and the healthcare systems. Real-world solutions depend on treatment protocols aimed at optimizing the number of clinical visits while guaranteeing good functional outcomes. We performed a retrospective analysis of 72 eyes from 63 naïve patients diagnosed with nAMD that underwent a fixed intravitreal protocol consisting of bimonthly injections after a three-month loading dose, with either Aflibercept or Ranibizumab (no predefined criteria for treatment selection). Best corrected visual acuity (BCVA) and optical coherence tomography were analyzed at baseline and during follow-up clinical visits (months 3, 6, 12, and 18). From the included participants, 42 followed a fixed regimen with Aflibercept and 30 with Ranibizumab. At the 12-month visit, there was not a statistically significant difference in the mean change of BCVA between the two groups (p=0.121); however, the mean difference in the central retinal thickness was significantly superior in the Aflibercept group (-142.2 versus -51.5, p=0.011). The described fixed regimen seems to be efficient in the treatment of nAMD in a clinical practice setting.

Real-World Effectiveness, Treatment Pattern, and Safety of Ranibizumab in Korean Patients with Neovascular Age-Related Macular Degeneration: Subgroup Analyses from the LUMINOUS Study

“…CRT reduction in treatment-naïve patients in this study (160.6 µm) was also better than other real-world studies of ranibizumab (51.5 µm in Providência et al). 27 The median time from diagnosis to treatment in treatment-naïve patients in this subgroup analysis was relatively short (4 days) compared with the global LUMINOUS population (12 days). 11 Korean patients can easily visit retina clinics without referral from primary physicians, and the short distance from home to clinics or hospitals in Korea might enable early detection and timely treatment of nAMD patients.…”

“…CRT reduction in treatment-naïve patients in this study (160.6 µm) was also better than other real-world studies of ranibizumab (51.5 µm in Providência et al). 27 …”

Antivascular Endothelial Growth Factor Dosing and Expected Acuity Outcome at 1 Year

“…The introduction of antivascular endothelial grow factor (VEGF) agents was a major advance in treating macular neovascularization in age-related macular degeneration. 1–40,41–70,71–96 The magnitude of effect of the anti-VEGF medications ranibizumab 2,61 and aflibercept 94 was apparent from the initial monthly dosing studies. Later studies based on a pro re nata (PRN) or a treat and extend (TE) dosing strategy produced visual acuity results that emulated, after a fashion, what was obtained with monthly dosing.…”

Real-World Outcomes of Intravitreal Aflibercept for Neovascular Age-Related Macular Degeneration: A Large-Scale Postmarketing Surveillance in Korea

“…34,35 However, observational studies including larger datasets reported reduced visual improvements; 2.9 ± 16.8 letters at 12 months in a study including 848 German patients with nAMD, 2.74 ± 7.06 letters at 12 months in a study including 31 Portugal patients with nAMD, and −0.39 letters at 12 months in a study including 4300 American patients with nAMD. [36][37][38] Although direct comparison is not possible due to the different study periods and demographics, our study reported relatively superior results with more than 3000 patients, most likely because most patients were treatment naïve and had a shorter disease duration. Korean patients can easily visit retinal clinics without referral from primary physicians, and the short distance from home to clinics or hospitals in Korea might enable early detection and timely treatment for patients with nAMD.…”