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Patrick Keating, Arthur S Kavanaugh; Switching anti-VEGF drug therapy in treatment of choroidal neovascularization and macular edema. Invest. Ophthalmol. Vis. Sci. 2014;55(13):590.
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To assess efficacy of switching intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy after developing decreased response or failure to respond during the course of treatment for choroidal neovascularization (CNV) or macular edema.
The authors retrospectively reviewed the records of 46 patients (52 eyes) who received at least two of the following anti-VEGF drugs: bevacizumab, ranibizumab, or aflibercept. Patients who demonstrated decreased response or failure to respond to an intravitreal anti-VEGF drug and who were subsequently switched to an alternative intravitreal anti-VEGF drug, within 6 weeks of initial injection, were included in this study.
18 eyes (from 18 patients) were included in this study. There were 18 alternations of intravitreal drug. 15 (83%) were initially treated with bevacizumab and then switched to ranibizumab. 3 (17%) were initially treated with ranibizumab and then switched to bevacizumab. Before switching intravitreal anti-VEGF drug the OCT central thickness increased an average of 2.9 microns, but after switching anti-VEGF drug this measurement decreased an average of 33.4 microns (P = 0.028). Before switching intravitreal anti-VEGF drug the OCT volume increased an average of 0.09 mm3, but after switching anti-VEGF drug this measurement decreased an average of 0.53 mm3 (P = 0.019).
Patients with CNV or macular edema who develop decreased response or failure to respond to ranibizumab may respond to another intravitreal anti-VEGF drug. The majority of cases (94%) in this study demonstrated a statistically significant increase in response to treatment after switching the intravitreal anti-VEGF drug.
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