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Laura Hall, Nazlee Zebardast, Ron Adelman; The efficacy of aflibercept in the treatment of neovascular age-related macular degeneration previously treated with bevacizumab or ranibizumab. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3799.
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To study the visual outcomes and change in central macular thickness (CMT) in patients with neovascular age-related macular degeneration (AMD) previously treated with ranibizumab and/or bevacizumab who were subsequently switched to aflibercept (VEGF Trap-Eye, Eylea®). Aflibercept was approved based on randomized clinical trial data which studied patients with untreated AMD. This study aims to determine the utility of aflibercept in patients who received previous anti-VEGF treatment.
A retrospective chart review of 22 patients who met the inclusion criteria: 1) previous anti-VEGF treatment for AMD, 2) at least 6-month follow-up and 3) available medical record. The main outcome measures were best-corrected Snellen visual acuity (BCVA) logMAR and central macular thickness (CMT) as measured by optical coherence tomography (OCT). These values were recorded at the initial baseline visit prior to the first aflibercept injection and at subsequent 1-month, 3-month, and 6-month follow-up clinic visits and/or injections.
The study population included 4 men and 18 women aged 78.0±3.20 years (mean±SEM) who received 5.36±0.38 aflibercept injections. Thirteen patients previously received only bevacizumab (9.00±2.26 injections), one received only ranibizumab (11 injections) and 8 received both anti-VEGF agents (mean 21.4 injections). BCVA logMAR at the initial baseline visit was 0.50±0.07 (mean±SEM) (mean VA 20/64), 1-month 0.52±0.07 (20/66), 3-month 0.41±0.07 (20/52), and 6-month 0.43±0.10 (20/54) (p-value 0.14, two-tailed paired t-test comparing initial and 6-month follow-up). CMT results for initial baseline visit were 301±30.8µm, 1 month 238±13.5, 3-month 236±11.1, and 6-month 247±10.7 (p-value 0.07, two-tailed paired t-test comparing initial and 6-month follow-up).
These findings demonstrate a trend towards improvement from baseline to 6-month follow-up in both BCVA and CMT in AMD patients previously treated with the mainstay agents ranibizumab and/or bevacizumab who were switched to aflibercept. Given the small sample size a larger study will be beneficial.
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