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Adeel Shaikh, Daniel Miller, Michael Petersen, Robert Foster, Christopher Riemann, Robert Sisk; Comparison of Intravitreal Aflibercept with Bevacizumab and Ranibizumab for the Treatment of Wet Age-related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3838.
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For the past 5 years, intravitreal injections of bevacizumab and ranibizumab have been the conventional treatment of wet age related macular degeneration (wAMD). Aflibercept is a recently FDA-approved drug indicated for the treatment of wAMD. Recent investigation suggests aflibercept may potentially have a longer biologic effect in vivo in wAMD compared to ranibizumab. We hypothesize that aflibercept may reduce injection frequency in patients with a maintenance anti-VEGF injection requirement for control of wAMD, and despite fewer office visits it will increase treatment healthcare cost per patient.
The records of patients seen at Cincinnati Eye Institute for wAMD between 2011 to 2012 were retrospectively reviewed. Patients receiving intravitreal injections of bevacizumab (IVA) or ranibizumab (IVL) for at least 6 months whose regimen was subsequently changed to aflibercept (IVE) and continued for at least 6 months were included in the study. Demographic data, ocular characteristics, interval between treatments, and cost per injection were collected and analyzed.
Thirty three eyes of 30 patients with wAMD were included in the study. There were 17 right and 16 left eyes in the series. Mean patient age was 79 years. There were 15 females and 15 males. Mean follow-up was 12 months. Indication for intravitreal therapy at each office visit was active wAMD. Eight eyes received IVL and 25 eyes received IVA injections initially. Subsequently all eyes received IVE injections. Average duration between IVA or IVL was 29 days, where as it was 34 days between IVE injections (p< 0.0004). No complications were noted. Total cost over 6 months of treatment with the IVA injections was $3700, $96000 for IVL injections and $366300 for IVE injections.
Aflibercept may be considered in the management of wAMD in select patient population to reduce frequency of injections, office visits and possibly complications. Our retrospective study suggests that aflibercept injections may offer a decreased injection frequency compared to IVA or IVL injections but does add a considerable healthcare cost per patient. Further studies need to be carried out comparing efficacy and visual outcomes in these groups.
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