Real-World Results of Switching Treatment from Ranibizumab to Aflibercept in Macular Oedema Secondary to Branch Retinal Vein Occlusion

Abstract

IntroductionTo investigate treatment outcomes after switching from ranibizumab to aflibercept intravitreal injections in patients with macular oedema (MO) secondary to branch retinal vein occlusion (BRVO).MethodsEligible patients with refractory MO secondary to BRVO, post treatment with a minimum of three intravitreal injections of ranibizumab at 4-weekly intervals were recruited. Suboptimal or non-responders were defined as patients who had persistent intraretinal fluid (< 75% decrease from baseline) despite a minimum of three consecutive injections. These patients were switched to aflibercept injections on an as-needed basis. The primary study outcomes assessed trends in best-corrected distance visual acuity (BCVA) and central retinal thickness (CRT). To compare means of BCVA and CRT, a paired t test two-tailed with a level of significance set at 0.05 was used. Pearson correlation coefficient was also applied to demonstrate correlation. Participants were followed up for a period of 24 weeks after switching.ResultsThirty-eight eyes of 38 patients were included in the study. Patients had an average of 8.37 ranibizumab intravitreal injections over a mean period of 12 months presenting suboptimal or no response. A significant decrease of mean CRT from 388.63 ± 93.4 μm to 290.29 ± 93.5 μm (p < 0.001) and an improvement in mean BCVA from logMAR 0.66 ± 0.38 to logMAR 0.57 ± 0.27 (p = 0.025) was achieved after an average of 2.27 aflibercept injections.ConclusionsGiven the spectrum of therapies available to date for the management of MO secondary to BRVO, aflibercept appears to be an effective treatment option in cases refractory to ranibizumab. This study based on a small cohort of patients indicates that satisfactory results on retinal anatomy and visual outcomes can be accomplished with a smaller number of injections. Larger-scale studies are needed to extrapolate these promising results.

Biological drug therapy for ocular angiogenesis: Anti‐VEGF agents and novel strategies based on nanotechnology

“…45 Finally, once proteins are expressed, post-translational modification is a key factor on their activity, which will be influenced by the host cell used to produce the protein such as mammalian cells, 43,44 plant cells, bacteria, and F I G U R E 1 Peer-reviewed published studies by year available on the PubMed database from advanced search of articles containing (((biological drugs) OR (biological medicine)) OR (biotherapeutic drug)) AND (((ocular) OR (eye)) OR (ophthalmic)) other microorganisms. 25,46,47 The most representative molecule of the RFP is aflibercept whose mechanism is similar to mAb, [48][49][50] but has a higher degree of VEGF binding. 51 BD also include the small group of medicines based on nucleic acids (e.g., DNA, mRNA, and synthetic oligonucleotides) and they also include cell and gene-based therapeutics, the latest and fastest growing class of BD.…”

Outcome of Switching Anti-VEGF&nbsp;Agents at Fixed Intervals to Treat Eyes With Macular Edema Secondary to Branch Retinal Vein Occlusion

“…There have been many studies on the effectiveness of switching from ranibizumab to a ibercept in patients with macular edema secondary to a BRVO. The patients studied can be classi ed into two types; one type is the patient who was not responding to ranibizumab and were then switched to a ibercept, [5,9,10] and the other type was the patient who had a difference in the duration of the effectiveness between two agents as indicated by the lengthening of the interval after switching to a ibercept. [6] The di culty in comparing these results is that there is a spontaneous healing in more than 30% of cases if macular edema secondary to BRVO develops within one year after the onset of BRVO.…”

The Impact of Aflibercept on Diabetic Macular Edema Patients Refractory to Ranibizumab in a Tertiary Care Eye Specialist Hospital, Saudi Arabia

“…12,18 Laginhas et al 19 and Ashraf et al 20 reported that Aflibercept treatment reduced CMT and improved visual acuity in the eyes than the previous Bevacizumab treatment. In addition to refractory DME cases, promising results have been reported with Aflibercept treatment for macular edema in branch vein occlusion, 21 central vein occlusion, 22 and edema due to choroidal vasculopathy, 23 which are frequent comorbidities of diabetic retinopathy or hypertension. We found no significant improvement in vision after Aflibercept treatment.…”