June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Long-term anatomical and functional outcomes in patients with neovascular age-related macular degeneration (nAMD) after switching from Ranibizumab to Aflibercept therapy
Author Affiliations & Notes
  • Louise Christou
    Ophthalmology, East Sussex NHS Trust, Hove, United Kingdom
  • Varo Kirthi
    Ophthalmology, East Sussex NHS Trust, Hove, United Kingdom
  • Helen Peregrine
    Ophthalmology, East Sussex NHS Trust, Hove, United Kingdom
  • Fariha Essaji
    Ophthalmology, East Sussex NHS Trust, Hove, United Kingdom
  • Sarah Canning
    Ophthalmology, East Sussex NHS Trust, Hove, United Kingdom
  • Pantelis Ioannidis
    Ophthalmology, East Sussex NHS Trust, Hove, United Kingdom
  • Shahram Kashani
    Ophthalmology, East Sussex NHS Trust, Hove, United Kingdom
  • Footnotes
    Commercial Relationships   Louise Christou, None; Varo Kirthi, None; Helen Peregrine, None; Fariha Essaji, None; Sarah Canning, None; Pantelis Ioannidis, None; Shahram Kashani, Bayer (F), Novartis (F)
  • Footnotes
    Support  none
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 907. doi:
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    • Get Citation

      Louise Christou, Varo Kirthi, Helen Peregrine, Fariha Essaji, Sarah Canning, Pantelis Ioannidis, Shahram Kashani; Long-term anatomical and functional outcomes in patients with neovascular age-related macular degeneration (nAMD) after switching from Ranibizumab to Aflibercept therapy. Invest. Ophthalmol. Vis. Sci. 2017;58(8):907.

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

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Abstract

Purpose : Eyes with limited clinical response to intravitreal Ranibizumab for nAMD demonstrate significant structural and functional improvement after conversion to intravitreal Aflibercept. Limited large cohort data exists on the long-term effects of switching therapies. This retrospective observational study investigated the changes in best corrected visual acuity (BCVA), central retinal thickness (CRT) and resolution of macular fluid in Ranibizumab-resistant nAMD patients up to three years after switching therapies.

Methods : Inclusion criteria were eyes with nAMD that had a minimum of six Ranibizumab injections prior to switching to Aflibercept and a minimum of twelve months’ follow-up after switching. Aflibercept regimens included a pro re nata (PRN) regime or a loading dose followed by PRN regime. Primary outcome measures were BCVA, CRT and time taken to achieve first resolution of macular fluid. Data was collected from electronic patient records (Medisoft Ltd) and statistical analysis performed to compare outcomes at different time points.

Results : Of the 235 eyes that met the inclusion criteria, eight were excluded due to incomplete data. Of the remaining 227 eyes (202 patients), 29.2% were male and 70.8% were female. with mean age of 83.0 years (79.0-88.0). Mean follow-up time was 29.5 months (28.0-33.0). Interquartile ranges are shown in brackets.
Mean BCVA at point of switching, at one year and at latest follow-up in LogMAR was 0.47 (0.30-0.60), 0.38 (0.20-0.60) and 0.45 (0.20-0.70), respectively. Significant improvement was demonstrated when comparing BCVA at point of switching with follow-up at one year (p<0.001).
Mean CRT at point of switching, at one year and at latest follow-up in micrometres was 286 (239-316), 259 (221-286) and 246 (212-269), respectively. Significant improvement was demonstrated when comparing CRT at point of switching with follow-up at one year and at latest follow-up (p<0.0001, p<0.0001).
Initial resolution of macular fluid was achieved during follow-up in 77.1% eyes at a mean of 4.7 months (2.0-6.0).

Conclusions : Resolution of macular fluid was achieved at some point in the majority of eyes. Both CRT and vision improved significantly when switching therapy, but only the effect on CRT was maintained over a long period of time.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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