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Arshad Khanani; Intravitreal aflibercept for wet age-related macular degeneration every 8 weeks may not maintain initial benefits. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4982.
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Since its approval for treating wet age-related macular degeneration (AMD) in the USA in November 2011, aflibercept has demonstrated good anatomical results in patients seemingly resistant to other anti-vascular endothelial growth factor (VEGF) agents. However, if aflibercept is given every 8 weeks as indicated, increasing clinical experience suggests that for some patients, these improvements are not maintained. This study investigated whether anatomical and visual acuity (VA) improvements could be maintained with injections given every 8 weeks.
Twenty patients with wet AMD treated at our clinic from December 2011 to November 2013 were included in this retrospective interventional case series. Only patients who received three initial monthly doses of aflibercept (2.0 mg) (in accordance with the product label and the protocol used in the VIEW trials) were included. Patients were followed up after the third monthly injection. Best-corrected VA (BCVA) and the presence of pigment epithelial detachments (PEDs) or intra- or sub-retinal fluid on optical coherence tomography were recorded at baseline and at each visit.
Data were collected for 20 patients with wet AMD (aged between 63 and 88 years). Sixteen patients (80%) had previously received prior anti-VEGF therapy. Four patients had PED at baseline. Following the initial monthly dosing, 15 patients (75%) had stable or improved VA, 14 patients (70%) had clinically meaningful reductions in sub-retinal fluid, and PED was stable or improved in three cases. At the fourth visit (mean 7.2 weeks after the third monthly injection), VA had decreased in 7 patients (35%), intra- or sub-retinal fluid had increased in 13 patients (65%) and PED returned in all patients who had initially responded, compared with the previous visit. In total, 13 patients (65%) could not be extended to every 8 week dosing.
Our data suggest that the recommended every 8 week aflibercept dosing after three monthly injections is not suitable for many patients with wet AMD. We recommend close monitoring after the three monthly injections, which should be more often than every 8 weeks, for all patients initiating therapy with aflibercept.
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