September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Aflibercept as a Second Line Therapy for Neovascular Age Related Macular Degeneration Following Initial Bevacizumab Therapy
Author Affiliations & Notes
  • Ori Segal
    Ophthalmology, Meir medical center, Tel-Aviv, Israel
    Ophthalmology, Sackler school of medicine, Tel-Aviv University, Tel-Aviv, Israel
  • Liran Tiosano
    Hadassah-Hebrew University Medical Center, Jerusalem, Israel
  • Ayala Pollack
    Kaplan Medical Center, Rehovot, Israel
  • Rita Ehrlich
    Rabin medical center, Petach-Tikva, Israel
  • Itamar Klemperer
    Soroka Medical Center, Beer-Sheva, Israel
  • Yoreh Barak
    Rambam Medical Center, Haifa, Israel
  • nurit mathalone
    Carmel Medical Center, Haifa, Israel
  • Michaela Goldstein
    Tel-Aviv medical center, Tel-Aviv, Israel
    Ophthalmology, Sackler school of medicine, Tel-Aviv University, Tel-Aviv, Israel
  • Itay Chowers
    Hadassah-Hebrew University Medical Center, Jerusalem, Israel
  • Footnotes
    Commercial Relationships   Ori Segal, Bayer Israel Ltd. (F); Liran Tiosano, Bayer Israel Ltd. (F); Ayala Pollack, Bayer Israel Ltd. (F); Rita Ehrlich, Bayer Israel Ltd. (F); Itamar Klemperer, Bayer Israel Ltd. (F); Yoreh Barak, Bayer Israel Ltd. (F); nurit mathalone, Bayer Israel Ltd. (F); Michaela Goldstein, Bayer Israel Ltd. (F); Itay Chowers, Bayer Israel Ltd. (F)
  • Footnotes
    Support  Bayer Israel Ltd. partial funding
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 522. doi:
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      Ori Segal, Liran Tiosano, Ayala Pollack, Rita Ehrlich, Itamar Klemperer, Yoreh Barak, nurit mathalone, Michaela Goldstein, Itay Chowers; Aflibercept as a Second Line Therapy for Neovascular Age Related Macular Degeneration Following Initial Bevacizumab Therapy. Invest. Ophthalmol. Vis. Sci. 2016;57(12):522.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Second line therapy in patients with neovascular age-related macular degeneration (nvAMD) was mostly evaluated in chronic cases following prolong usage of first line treatment. This study aims to evaluate second line aflibecept therapy in nvAMD eyes showing partial or lack of response for initial therapy with bevacizumab.

Methods : The Aflibercept as a Second Line Therapy for nvAMD in Israel (ASLI) study is a prospective, multi-center (n=8), open-label, clinical trial. Forty seven nvAMD eyes that had persistent intra retina, sub retinal, or pigment epithelium detachment following 3-9 initial bevacizumab injections. Three monthly intravitreal aflibercept (2mg) injections were administered followed by two bi-monthly injections (weeks 16 and 24), and a final examination at week 28th. According to the investigator discretion, an additional injection was given at week 20. Best corrected visual acuity (BCVA) was evaluated with an Early Treatment Diabetic Retinopathy Study (ETDRS) chart and spectral-domain optical coherence tomography (SD-OCT) was performed at each visit. Baseline and final fluorescein angiography were also performed. Change in the central sub-field macular thickness (CST) from baseline to week 28 on OCT was defined as the primary end-point. Secondary end-points included the mean change in BCVA, and structural changes in OCT and FA.

Results : Mean±SD patient's age was 75.2±8.9 years. The mean±SD number of bevacizumab injections prior to enrollment to the study was 5.5±2.1 (range 3-9). CST reduced from mean±SD of 409±127 microns at baseline to 345±89 microns at week 8 (n=43, p<0.05; paired T-Test). 24/47 eyes had at least 5 letters gain, while 9 lost 5 or more letters. Five eyes lost 15 letters or more and 5 gain 15 letters or more. Twenty four patients required the optional treatment at week 20.

Conclusions : Interim results from the ASLI study demonstrate decrease in CST after the first 2 aflibercept injections, and improved BCVA at the end of the study. These preliminary results suggest that intravitreal aflibercept may be effective in eyes with nvAMD that show lack or partial response to initial bevacizumab treatment.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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