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Clement K Chan, Atul Jain, Srinivas R Sadda, Neeta Varshney, ANTI-VEGF TRANSITION STUDY GROUP FOR AMD; Results at Six Months after Conversion to Aflibercept for Patients on Prior Ranibizumab or Bevacizumab Treatment for Exudative Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3948.
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To study vision and OCT results and complications at 6 months (mo) after conversion from intravitreal ranibizumab and/ or bevacizumab to aflibercept for treatment of eyes with exudative age-related macular degeneration (eAMD).
Retrospective study evaluating 6 monthly OCT (Cirrus) scan data post-conversion (Conv) to aflibercept for eyes on prior Legacy ranibizumab, Legacy bevacizumab, or Mixed treatment for eAMD. Pre versus. post-Conv & inter-group comparisons were analyzed. Outcome measures were: Macular volume; Central 1- and 3mm subfield; subretinal fluid (SRF), cystoid macular edema (CME), pigment epithelial detachment (PED) heights (Ht) and volumetrics (Vol) by simplified method per Heussen et al (Invest Ophth Vis Sci 2011;52:7792-8); best spectacle and pinhole VA for each visit. Single masked investigator performed all OCT measurements. Adhering to strict inclusion/exclusion criteria, all conditions that could confound results were excluded. All adverse events were recorded.
From 11/11 to 2/13,189 eyes (E)/172 patients, 66 men) (mean age:83.4) in Legacy ranibizumab (84E), Legacy bevacizumab (95E), or Mixed (10E) groups were converted (Conv) to aflibercept and followed for 6 mo. Mean pre and post-Conv injections at 6 mo were 6.5 vs 5.4, respectively. Baseline characteristics among all groups were comparable. Significant decreases were noted pre vs pos-Conv in SRF/CME Ht and Vol (all P<0.001). Similar findings were noted for PED Ht (122.8 vs. 79.4 µm) and PED Vol (all P<0.001). Post-ConvVA was better (20/43 vs. 20/51, p<0.001). There was reduced SRF, CME, & PED Ht and Vol post-Conv for Legacy ranibizumab and bevacizumab groups (P=0.003 to <0.001). No differences among all drug groups were noted in OCT and VA changes. Post-Conv VA, SRF/CME & PED Ht and Vol were improved for Non-responders (suboptimal response to bevacizumab/ranibizumab), (p=0.001 to <0.001), but not Responders (good response to same)--stable conditions at 6 mo. Only adverse event was RPE tear in1E.
Study eyes showed significant improvements in vision and all OCT metrics (PED, SRF, and CME) at 6 mo after switching from bevacizumab and/or ranibizumab to aflibercept. Post-Conv VA and OCT measures were similar for eyes on prior bevacizumab or ranibizumab. Post-Conv adverse events were uncommon.
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