Comparison of outcomes after switching treatment from intravitreal bevacizumab or ranibizumab to aflibercept in neovascular age-related macular degeneration

Abstract

Purpose: To compare outcomes in patients with neovacular age-related macular degeneration (AMD) after switching from previous intravitreal bevacizumab or ranibizumab to aflibercept. We hypothesize that aflibercept will provide an equivalent or improved therapeutic effect.

Methods: A retrospective comparative case series, comparing patients who were recalcitrant to treatment (persistent subretinal fluid seen on optical coherence tomography (OCT)) to patients who were dry (no subretinal fluid seen on OCT) at time of the switch to aflibercept treatment. All reviewed patients had at least 3 previous injections with bevacizumab or ranibizumab, and all had an injection within 45 days prior to switching to aflibercept. Each patient received 3 monthly injections of aflibercept. Main outcome measures included visual acuity (VA) and central retinal thickness (CRT).

Results: 86 eyes met the inclusion criteria for the study. There were 63 eyes (73.3%) in the recalcitrant group and 23 eyes (26.7%) in the dry group at the initiation of aflibercept treatment. VA did not change significantly within or between each group at any time point in either the recalcitrant group (0.57logMar, SD 0.39 vs. 0.52logMar SD 0.39; p=0.28) or the dry group (0.47logMar, SD 0.36 vs. 0.54logMar, SD 0.37; p=0.07). Among those in the recalcitrant group, CRT decreased significantly from visit 1 (mean 262.02, SD 85.6) to visit 2 (mean 245.98, SD 90.29; p=0.04) and from visit 1 to visit 3 (mean 237.91, SD 71.97; p=0.01). By visit 4 this decrease in CRT was no longer significant (mean 248.62, SD 77.86; p=0.07). Among those in the dry group, CRT did not change significantly over time. The CRT was not significantly different between groups at any time point.

Conclusions: In patients switched from bevacizumab or ranibizumab to aflibercept, there was a temporary decrease in CRT among patients who were in the recalcitrant group, however there were no apparent differences in visual acuity outcomes in either the dry or recalcitrant group. Aflibercept appears to provide a non-inferior therapeutic effect when compared to ranibizumab and bevacizumab. No visual benefit was seen by changing to aflibercept in either the dry or recalcitrant groups.

Keywords: 412 age-related macular degeneration • 688 retina • 462 clinical (human) or epidemiologic studies: outcomes/complications