Switch to Aflibercept in the Treatment of Neovascular AMD: Long-Term Results

Cardoso, Pedro; Pinheiro, Ana Fernanda; Meira, Jorge; Pedrosa, Ana Catarina; Falcão, Manuel; Pinheiro-Costa, João; Falcão‐Reis, Fernando; Carneiro, Ângela

doi:10.1155/2017/6835782

Cited by 10 publications

(10 citation statements)

References 24 publications

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“…At 4 years, the CMT was maintained at 295 µm. Similarly, other switch studies demonstrated reduction in CMT [16][17][18][19]. In a retrospective switch study conducted by Cardoso et al, they evaluated patients who were switched from ranibizumab to aflibercept and the CMT decreased from baseline of 386.2 μm to 266.1 μm by year 3 [16].…”

Section: Discussionmentioning

confidence: 94%

“…Similarly, other switch studies demonstrated reduction in CMT [16][17][18][19]. In a retrospective switch study conducted by Cardoso et al, they evaluated patients who were switched from ranibizumab to aflibercept and the CMT decreased from baseline of 386.2 μm to 266.1 μm by year 3 [16]. Wykoff et al published a 6-month prospective switch study to IAI with, CMT decreasing by 27.3 µm from time of switch [17].…”

Section: Discussionmentioning

confidence: 96%

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Long term results of patients with neovascular age-related macular degeneration switched from other anti-VEGF agents to intravitreal Aflibercept

et al. 2022

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Background This study explores the long term anatomic and functional results of patients who were switched to intravitreal aflibercept injections (IAI) after being initially managed with other anti-VEGF agents for neovascular age-related macular degeneration (nAMD). Methods Patients with nAMD were included if they started with another anti-VEGF agent and were switched to IAI. Subjects had at least 3 years of consistent therapy with IAI and at least 1 injection quarterly. Results Eighty-eight patients had at least 3 years of treatment while 58 of those patients, had at least 4 years of IAI. Average treatment time with other anti-VEGF agents was 32 months prior to switching. Baseline best corrected vision (VA) was 59.4 letters (20/70 + 2). At time of switch, VA increased significantly to 66.7 letters (20/50 + 2). At 3 months after switch, VA increased significantly to 69.0 (20/40−) letters. After 3 years of consistent IAI, vision was 67.5 letters (20/40−2), and for those patients that completed 4 years of therapy, the average VA was 66.0 letters (20/50 + 2), with a gain of 6.6 letters over baseline vision. 32.1% of patients gained 3 or more lines of vision. Initial central macular thickness (CMT) was 369 µm, which improved to 347 µm at time of switch, and further improved at 3 months to 301 µm and was maintained over time. Conclusion Patients switched to IAI can maintain vision over the long term. Patients treated on average for 5.7 years, had a visual gain of 8.1 letters after 3 years and 6.6 letters after 4 years of IAI therapy. CMT significantly improved following the switch and was maintained.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 96%

Long term results of patients with neovascular age-related macular degeneration switched from other anti-VEGF agents to intravitreal Aflibercept

et al. 2022

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“…Although VEGF family proteins activate three types of VEGF receptors (VEGFRs), the VEGFA/VEGFR2 axis elicits the most potent angiogenic activity and vascular permeability. Consequently, anti-VEGF drugs have shown great promise for the treatment of CNV (Angkawinitwong et al ., 2017; Neves et al ., 2017). Indeed, intravitreal injection of the VEGF antagonists ranibizumab (Lucentis) and aflibercept (Eylea) has been widely used to treat AMD (Mitchell et al ., 2018).…”

Section: Introductionmentioning

confidence: 99%

Arg-Leu-Tyr-Glu Suppresses Retinal Endothelial Permeability and Choroidal Neovascularization by Inhibiting the VEGF Receptor 2 Signaling Pathway

Park

Baek

Kim

et al. 2019

Biomolecules & Therapeutics

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Vascular endothelial growth factor (VEGF) plays a pivotal role in pathologic ocular neovascularization and vascular leakage via activation of VEGF receptor 2 (VEGFR2). This study was undertaken to evaluate the therapeutic mechanisms and effects of the tetrapeptide Arg-Leu-Tyr-Glu (RLYE), a VEGFR2 inhibitor, in the development of vascular permeability and choroidal neovascularization (CNV). In cultured human retinal microvascular endothelial cells (HRMECs), treatment with RLYE blocked VEGF-A-induced phosphorylation of VEGFR2, Akt, ERK, and endothelial nitric oxide synthase (eNOS), leading to suppression of VEGF-A-mediated hyper-production of NO. Treatment with RLYE also inhibited VEGF-A-stimulated angiogenic processes (migration, proliferation, and tube formation) and the hyperpermeability of HRMECs, in addition to attenuating VEGF-A-induced angiogenesis and vascular permeability in mice. The anti-vascular permeability activity of RLYE was correlated with enhanced stability and positioning of the junction proteins VE-cadherin, β-catenin, claudin-5, and ZO-1, critical components of the cortical actin ring structure and retinal endothelial barrier, at the boundary between HRMECs stimulated with VEGF-A. Furthermore, intravitreally injected RLYE bound to retinal microvascular endothelium and inhibited laser-induced CNV in mice. These findings suggest that RLYE has potential as a therapeutic drug for the treatment of CNV by preventing VEGFR2-mediated vascular leakage and angiogenesis.

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“…Real-life data pertaining to the long-term stability under treatment with Aflibercept beyond two to three years are still scarce,32–35 and few papers addressed predictive factors for long-term functional stability 36–41. Clinical experience has taught that independent of the anti-VEGF drug in use, the PRN treatment strategy in RCTs and clinical practice has an inherent risk of under-treatment since lesion activity indicated by intraretinal fluid triggers re-treatment.…”

Section: Introductionmentioning

confidence: 99%

<p>Twelve-week dosing with Aflibercept in the treatment of neovascular age-related macular degeneration</p>

Garweg

2019

OPTH

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Purpose To review published evidence for a treatment interval extension to ≥12-weeks in neovascular macular degeneration treated with intravitreal Aflibercept. Methods A systematic search was performed in the NCBI/PubMed database to identify pro- and retrospective studies retrieved by the key terms or and or AND AND and included all papers that used a treat-and-extend (T&E) protocol including a loading phase of 3 intravitreal anti-VEGF injections and a minimal follow-up of 2 years. Disease stability was defined as the absence of any intraocular and absence or stability of subretinal fluid and pigment-epithelial detachment. Results Four studies were identified that reported information pertaining to disease stability or treatment extension beyond 12 weeks under intravitreal Aflibercept therapy including 1,102 eyes in total. Following a T&E protocol, a mean of 62.9% achieved disease stability and a 6.9 letter gain based on 11.9 injections over 24 months of Aflibercept treatment. As much as 43.0% of all eyes or 64.1% of the eyes with stable disease were maintained on ≥12-weekly injection intervals. Conclusions A consequent treatment with a null tolerance for intraretinal fluid is prerequisite to induce stability and maintain visual gain after the loading phase. Using Aflibercept in a T&E protocol, disease stability and interval extension to ≥12 weeks were reported in 43% of the eyes by end of the second year with less injections, but similar results as under fix dosing. A lower treatment burden strongly argues for an individualized proactive treatment regimen.

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Switch to Aflibercept in the Treatment of Neovascular AMD: Long-Term Results

Cited by 10 publications

References 24 publications

Long term results of patients with neovascular age-related macular degeneration switched from other anti-VEGF agents to intravitreal Aflibercept

Long term results of patients with neovascular age-related macular degeneration switched from other anti-VEGF agents to intravitreal Aflibercept

Arg-Leu-Tyr-Glu Suppresses Retinal Endothelial Permeability and Choroidal Neovascularization by Inhibiting the VEGF Receptor 2 Signaling Pathway

<p>Twelve-week dosing with Aflibercept in the treatment of neovascular age-related macular degeneration</p>

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