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Maddalena Quaranta, Francois Devin; Switch from aflibercept to ranibizumab: Up to 2 years follow-up post View2 study. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3935.
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Outcomes of patients treated solely with aflibercept A2 mg or ranibizumab R0.5 mg, after the end of the VIEW2 study, over a period of up to 2 years.
Retrospective study of patients followed up after the VIEW2 study ended. Our patients belonged to one of the groups: A2q4, A2q8 or Rq4. We investigated the period during which the patients were treated as needed (PRN regimen) with ranibizumab.
Among the 5 Rq4 patients with monthly IVTs in the 1st year, 3 patients received 3 IVTi the 2nd year (capped PRN) and 2 patients had 4 IVTs. After switching, 3 patients received as many or fewer injections than in year 2 and 2 patients needed more injections. VA remained stable throughout this period in all but one patient. Of the 4 A2q4 patients, 2 were withdrawn from VIEW during the 2nd year. The 3rd patient received only 1 IVT of ranibizumab in the 3rd year and 3 IVT in the 4th year, with stable VA. The 4th patient received 5 IVT during the 2nd year, and 6 IVT over 12 months after switching, with stable VA. Of the 6 A2q8 patients, one patient was withdrawn in the first year of VIEW and was then treated with 13 IVT of R over 15 months, with stable VA. 3 patients received 3, 4 and 7 IVT respectively in the 2nd year and no IVT in the following 12 months, with stable VA. 2 other patients required 3 and 4 IVT in the 2nd year then 5 to 7 IVT after switching, with stable VA.
Switching from a fixed dosing regimen with aflibercept to a PRN regimen with ranibizumab allowed anatomic and functional results to remain stable without increasing the number of IVT in all but one patient. For the latter patient, it would seem either that the switch from one molecule to another was not beneficial or that the wAMD had progressed. For our patients, the number and timing of injections appear to be unrelated to the anti-VEGF agent used. Although the fixed dosing regimen every 2 months followed by a capped PRN yields satisfactory results on average, a fixed dosing regimen without follow-up would not be more effective in treating recurrence and would lead to over- or under-treatment. It seems that the PRN regimen remains the most suitable for treatment individualization. Larger scale studies will however be needed to confirm these findings.
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