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Sebastian M Waldstein, Christian Simader, Giovanni Staurenghi, Michael Larsen, Paul Mitchell, Ursula Schmidt-Erfurth; Antiangiogenic efficacy of intravitreal aflibercept versus ranibizumab in a fixed and a PRN-guided regimen in the VIEW2 trial. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3959.
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To investigate the impact of aflibercept versus ranibizumab treatment on the intraretinal, subretinal and sub-pigment epithelial (sub-RPE) pathomorphologic compartments using optical coherence tomography (OCT) in the VIEW2 trial.
In the VIEW2 trial, 906 patients with treatment-naïve neovascular age-related macular degeneration (AMD) were randomized to receive intravitreal aflibercept 2.0mg injections or ranibizumab 0.5mg treatment in a fixed monthly or bimonthly (Week 0-48) and subsequent pro re nata (PRN) (Week 52-96) regimen (with mandatory dosing quarterly). Standardized monthly OCT evaluation was performed by an independent certified reading center (Vienna Reading Center, VRC) for three major morphological parameters: intraretinal fluid/cysts (IRC), subretinal fluid (SRF) and pigment-epithelial detachment (PED).
At baseline, the presence of IRC, SRF and PED was balanced between the treatment arms, with approximately 65% of eyes presenting with IRC, 86% with SRF and 80% with PED. After 3 initial monthly doses, the rates of IRC, SRF and PED had decreased to 21%, 27% and 55% respectively with ranibizumab treatment, and to 18%, 16% and 54% respectively with aflibercept treatment. In SRF and IRC, resolution rates and the differences between aflibercept and ranibizumab were maintained over time throughout the first study year with a fixed regimen. While the proportion of PED remained stable with ranibizumab, PED decreased continuously with aflibercept treatment in the monthly as well as the bimonthly regimen. During the PRN regimen however, recurrence of PED together with IRC was observed and IRC recurrence was associated with BCVA loss. Synchronized spikes in fluid recurrence were seen in all three compartments with the bimonthly and quarterly retreatment pattern.
Intravitreal aflibercept demonstrated a significantly superior drying effect in all retinal and sub-RPE compartments compared to ranibizumab. Although bimonthly aflibercept was equally effective as monthly treatment in terms of visual acuity, an increase in lesion activity was detected on OCT following treatment-free periods with progressive functional loss with PED and IRC reccurrence.
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