Transitioning to intravitreal aflibercept following a previous treat-and-extend dosing regimen in neovascular age-related macular degeneration: 24-month results

Abstract

Purpose: To evaluate frequency of injections, visual and anatomical outcomes of neovascular age-related macular degeneration (nAMD) patients transitioned to intravitreal aflibercept after failure to extend treatment interval beyond 8 weeks with prior intravitreal bevacizumab or ranibizumab. Methods: Retrospective review of patients with nAMD switched to aflibercept following ≥ 6 prior intravitreal ranibizumab or bevacizumab injections at 4-8-week intervals. Three monthly aflibercept injections were given followed by a treat-and-extend dosing regimen. Results: Twenty-one eyes of 18 patients who had received a mean of 23.8 ± 18.8 (mean ± SD; range 6-62) prior ranibizumab or bevacizumab injections were included. Over a mean follow-up of 24 months after the transition, 9.2 ± 2.9 (range 4-21) aflibercept injections were required. Interval between aflibercept injections increased to 57.3 days (range 35-133 days), as compared with 37 ± 6.1 days (range 29-54 days) with the prior agents (P = 0.01). Mean best-corrected visual acuity was preserved (0.42 ± 0.31 vs 0.42 ± 0.23 logMAR; P = 0.2). Mean OCT central subfoveal thickness (292.1 ± 83.2 μm to 283.6 ± 78.6 μm; P = 0.4) and mean macular volume (7.9 ± 0.95 mm 3 to 7.67 ± 0.94 mm 3 ; P = 0.16) remained stable. Conclusion: Patients requiring treatment more frequently than every 8 weeks with ranibizumab and bevacizumab were transitioned to 48-week treatment interval with aflibercept while maintaining the anatomic and visual gains.

Switch to aflibercept or ranibizumab after initial treatment with bevacizumab in eyes with neovascular AMD

“…Our results are in accordance with studies investigating both the outcome after switching from ranibizumab and/or bevacizumab to aflibercept [3, 8–14, 18] and after switching from bevacizumab to ranibizumab [5, 15, 16]. Fassnacht-Riederle et al only found minimal functional improvement when switching to aflibercept after initial treatment with ranibizumab and/or bevacizumab: Visual acuity increased about 1.8 letters in ETDRS visual acuity score but did not reach statistical significance [3].…”

Switching from pro re nata to treat‐and‐extend regimen improves visual acuity in patients with neovascular age‐related macular degeneration

“…; Homer et al. ). There are several adverse events and complications associated with intravitreal injections (Falavarjani & Nguyen ), of which some are clearly correlated to the number of injections while others may be related to the type of medication being injected.…”

Real-life outcomes in patients with neovascular age-related macular degeneration switched from ranibizumab to aflibercept

“…However; CMT improvement was found to be showed a significant improvement in both visual and anatomical outcomes in switched eyes. Conversely, Homer et al [24] did not report an improvement but a maintanance in macular thickness and visual acuity. Finally, Pinheiro-Costa et al [26] demonstrated only an anatomical improvement in switched eyes.…”

“…Since Kumar et al reported that a significant improvement in visual acuity was not observed after initial three injections but it was occured 6 months later [23]. On the other hand, Homer et al did not declare a significant improvement in BCVA in their 24-month follow-up [24]. Most probably, BCVA improvement depends on multiple variables, such as initial IS/OS integrity, increasing age, increasing CMT, the presence of IRF and presence of PED [28].…”

“…Several studies showed a significant improvement in visual and anatomical outcomes in eyes with persistent subfoveal fluid after switching to intravitreal aflibercept despite previous anti-VEGF treatment with ranibizumab or bevacizumab [23][24][25][26][27]. However, there are conflicting results.…”