September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Non-responders to multiple ranibizumab injections in treatment of exudative age-related macular degeneration and the effect of the switch treatment to aflibercept.
Author Affiliations & Notes
  • katerina manethova
    Department of Ophthalmology of 1st Faculty of Medicine of the Charles University and the Military University Hospital Prague, Military University Hospital Prague, Prague, Czech Republic
  • Jan Ernest
    Department of Ophthalmology of 1st Faculty of Medicine of the Charles University and the Military University Hospital Prague, Military University Hospital Prague, Prague, Czech Republic
  • Pavel Nemec
    Department of Ophthalmology of 1st Faculty of Medicine of the Charles University and the Military University Hospital Prague, Military University Hospital Prague, Prague, Czech Republic
  • Leos Rejmont
    Department of Ophthalmology of 1st Faculty of Medicine of the Charles University and the Military University Hospital Prague, Military University Hospital Prague, Prague, Czech Republic
  • Fredy Manolo Folleco
    Department of Ophthalmology of 1st Faculty of Medicine of the Charles University and the Military University Hospital Prague, Military University Hospital Prague, Prague, Czech Republic
  • Footnotes
    Commercial Relationships   katerina manethova, None; Jan Ernest, None; Pavel Nemec, None; Leos Rejmont, None; Fredy Folleco, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 549. doi:
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      katerina manethova, Jan Ernest, Pavel Nemec, Leos Rejmont, Fredy Manolo Folleco; Non-responders to multiple ranibizumab injections in treatment of exudative age-related macular degeneration and the effect of the switch treatment to aflibercept.. Invest. Ophthalmol. Vis. Sci. 2016;57(12):549.

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

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Abstract

Purpose : Ocular anti-VEGF therapy has been in wide clinical use for many years. ANCHOR, MARINA and other follow-up trials proved high treatment efficiency, stabilization of visual functions after treatment and in significant amount of cases visual gain as well. However, anti-VEGF therapy is not successful in every patient with exudative AMD. Many eyes with regular dosing of ranibizumab injections manifest persistent fluid on time-domain optical coherence tomography (OCT) which limits further visual improvement. Now, 10 years after anti-VEGF treatment was introduced, it starts to show that approximately 12-17% of patients do not respond sufficiently to this treatment.

Methods : Retrospective cohort of 207 treatment naïve patients were treated with ranibizumab injections in pro re nata (PRN) regime. As non-responders were assessed patients with visual loss ≥ 0.2 logMar and with evidence of persistent fluid on OCT.
Non-responders to ranibizumab treatment were switched to aflibercept treatment in fixed regime (2.0 mg aflibercept administered every 4 weeks for the first 3 months and then every other month).

Results : Results include the assessment of annual monitoring of 45 eyes after switch to aflibercept therapy. Following parameters were assessed: mean change in Early Treatment Diabetic Retinopathy Study best corrected visual acuity (ETDRS BCVA), central subfield retinal thickness (CRT), number of patients with no fluid on OCT and patients who lost > 15 letters.

Conclusions : The treatment switch from ranibizumabu to aflibercept resulted in anatomical improvements. In the observed group, the central retinal thickness was reduced from the original 391,2 µm to 322,8 µm at the end of the observed period, but the change was not statistically significant.
Despite no improvements to the best-corrected visual acuity values, stabilisation of visual functions and OCT (optical coherence tomography) post therapy switch (due to non-response to the originally administered treatment connected with visual functions loss) represents both anatomical and functional success.
Non-responders percentage representation in the observed group (14,5 %) corresponds to the available published data.
In one case, tachyphylaxis developed gradually also to the Eylea treatment (aflibercept). After ranibizumab re-administration, anatomical and functional values stabilised

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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