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Gregory Lee, Jordana Fein, Elias Reichel; Age-Related Macular Degeneration: Patient Response and Outcomes to Aflibercept using PRN Dosing Regimen. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3817.
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To evaluate the response and outcomes in patients with age-related macular degeneration (AMD) treated with intravitreal aflibercept in a PRN dosing regimen.
Retrospective chart review of 19 eyes of 17 subjects, with a diagnosis of neovascular AMD, treated at the New England Eye Center, Tufts Medical Center, between February and December 2012 by one retina specialist. Patients were treated with intravitreal aflibercept using a PRN treatment regimen, with re-treatment criteria being the presence of new or persistent intra-retinal or sub-retinal fluid. All patients were followed with spectral domain optical coherence tomography (OCT) macular scans and a dilated ophthalmologic exam. Outcome measurements included anatomic response as measured on OCT, interval between follow-up visits, and interval between repeat injections.
The 19 eyes received an average of 1.84 aflibercept injections over a mean follow-up time of 20.29 weeks. The mean interval between follow-up visits was 5.18 weeks and the mean interval between injections was 11.18 weeks. 14 eyes had been treated previously with ranibizumab or bevacizumab with an average of 6.62 prior injections (Range 1-11). Of these, 5 eyes (5/14, 36%) were non-responsive to other anti-vascular endothelial growth factor (anti-VEGF) medications, defined as persistent intra-retinal or sub-retinal fluid after previous injection; 4 of these non-responders (80%) responded to intravitreal aflibercept with anatomic resolution of fluid. This group of previous non-responders received a mean of 2 aflibercept injections, with a mean interval between injections of 11.20 weeks (Range: 7-18), and a total mean follow-up time of 25.91 weeks. 2 eyes of 2 patients were aflibercept non-responders (2/19 = 11%). One eye was a non-responder to other anti-VEGF agents and the second eye was treatment naïve and failed both 2 aflibercept and 2 bevacizumab injections.
The results of this study, albeit limited due to small sample size and short duration of follow-up, suggest that the interval to repeat injection of aflibercept may be longer than with older anti-VEGF agents using a PRN dosing regimen. Furthermore, this study demonstrates the successful use of intravitreal aflibercept in patients who were previously non-responsive to either intravitreal ranibizumab or bevacizumab.
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