Response of eyes with age-related macular degeneration to anti-VEGF drugs and implications for therapy planning

Abstract

PurposeTo evaluate the response to and dependence on aflibercept or ranibizumab in patients with age-related macular degeneration (AMD).MethodsWe retrospectively reviewed AMD patients who received induction therapy with aflibercept or ranibizumab for the following parameters: whether complete resolution of the retinal fluid (“good response”) was achieved and whether recurrence was observed within 3 months (“dependent”) after the induction treatment. With aflibercept treatment, treatment-naïve eyes with a good response/non-dependence were recommended a pro re nata regimen, and other eyes were recommended a proactive bimonthly regimen, followed by monitoring of visual acuity (VA) for 12 months. The measured values of the groups were compared using one-way analysis of variance with Tukey’s test to evaluate the difference between baseline and postinjection VA.ResultsAmong the treatment-naïve eyes, 76% had a good response to aflibercept and 37% of these were aflibercept-dependent, while 58% had a good response to ranibizumab but 51% of these were ranibizumab-dependent. Among the eyes that converted from ranibizumab treatment, 92% of the good responders to ranibizumab with dependence and 76% of the poor responders on ranibizumab had a good response to aflibercept. With aflibercept treatment, the mean VA of treatment-naïve patients was significantly better than the baseline VA over 12 months (P<0.001), and the VA of the converted group improved significantly with proactive treatment and the improvement was continuously maintained from 6 to 12 months.ConclusionThe evaluation of response to and dependence on anti-vascular endothelial growth factor therapies in AMD was useful and practical in managing therapeutic protocols to obtain a good VA.

Long-term results of photodynamic therapy or ranibizumab for polypoidal choroidal vasculopathy in LAPTOP study

“…We reported that the evaluation of the response and dependence on anti-VEGF agents in AMD was useful and practical in managing protocols to obtain a good VA 19. We had also applied the PrONTO study procedures20 for patients treated with ranibizumab as retreatment criteria in the LAPTOP study, and after switching to aflibercept, the patients were retreated when any fluid was observed in OCT. That may also explain why the achievement rate of dry macula also increased at 5years in the ranibizumab group.…”

Aflibercept Treatment Results and Association with Baseline Characteristics in Cases of Newly Diagnosed Neovascular Age-Related Macular Degeneration

“…Minami et al 9 used an aflibercept regimen of 3 consecutive monthly injections followed by treatment at 2-month intervals in naive nvAMD eyes with good baseline visual acuity and reported a significant increase in visual acuity from month 2, as well as “dry macula” (no exudative findings on OCT) in 80% of eyes after the 3 loading doses and in 66% and 71% at months 6 and 12, respectively. In a similar study, Miyamoto et al 10 reported anatomical success rates of 37%, 62%, and 81% at months 3, 6, and 12, respectively, in eyes with naive AMD given aflibercept at 2-month intervals following a 3-month loading dose. Looking at studies conducted in our country, Erden et al 11 evaluated the anatomic and functional efficacy of aflibercept and ranibizumab in nvAMD and observed statistically significant positive changes at the end of 12 months with the pro re nata protocol in the aflibercept arm of the study.…”

“… 4 , 16 , 17 When our study results were analyzed, it was observed that the presence of PCV at diagnosis was not associated with anatomic response to IVA treatment in group 1 or 2 (p>0.999, p=0.801, respectively). Miyamoto et al 10 also reported that the presence of PCV did not affect anatomic response to IVA in their study of naive eyes with nvAMD, nearly half of which had PCV, while Ijiri and Sugiyama 18 reported an anatomic success rate of 97% in naive eyes with PCV after 3 consecutive IVA injections.…”

“…In group 1, anatomic responses were poorer in the presence of PED at diagnosis compared to the absence of PED and with serous PED compared to other PED types, whereas there was no significant association between the presence of PED or its subtypes and anatomic response in group 2. In their study, Miyamoto et al 10 found that detection of PED at diagnosis was associated with inadequate response to IVA therapy, while Ying et al 20 reported that patients with PED at diagnosis may have functional abnormalities in RPE activity that result in poorer anatomical response. Nagai et al 21 investigated the reasons for nonresponse to IVA therapy and reported that the presence of serous PED at diagnosis negatively affected anatomic treatment response, similar to our results.…”

Role of inflammatory factors in the effects of aflibercept or ranibizumab treatment for alleviating wet age‑associated macular degeneration

“…AMD-associated pathways and factors that stimulate CNV remain to be fully elucidated. However, vascular endothelial growth factor A (VEGF-A), a cytokine that promotes angiogenesis and vascular permeability, is one of the most important factors that promotes neovascularization (6). Active forms of VEGF-A have been identified in CNV (7)(8)(9).…”