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Benjamin Guidry, Ching Chen; Eylea Rescue Therapy in Eyes with Proven Non-Response to Other anti-VEGF Molecules. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3806. doi: https://doi.org/.
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In the treatment of wet AMD, nonresponsiveness to traditional anti-VEGF agents such as Lucentis(ranibizumab) or Avastin(bevacizumab) is an unfortunate reality for many patients. This study's purpose is to investigate beginning Eylea(aflibercept) treatment in patients with proven nonresponsiveness to Lucentis or Avastin
Eyes included in the study must have active choroidal neovascular membranes secondary to macular degeneration that have required a minimum of 5 consecutive Avastin or Lucentis injections due to lack of CNV resolution. Eyes included in the study must have no other major pathology such as prior non-cataract surgery or other confounding variables. Included eyes then begin Eylea rescue therapy consisting of Eylea initiation treatment per package guidelines, specifically three consecutive monthly injections followed by assessments every two months following with as needed injections. Acuity is recorded for every office visit. Patients also receive a macular OCT, fundus exam, and intraocular pressure monitoring at each visit.
A total of 52 patients and 60 eyes met inclusion criteria and were included in the study. Of these 60 eyes, 15(25%) showed complete resolution of CNV activity at or within the initial three month treatment window. Subsequent follow-up shows that only a single additional eye showed resolution of CNV activity following the inital three month period. Therefore 26.7% of eyes showed complete resolution of CNV activity at some point during treatment. Also of note, in total 28 eyes (46.7%) displayed improved acuity following 3 Eylea rescue injections and 18 eyes (30%) showed decreased acuity following 3 injections. 14 eyes (23.3%) displayed no change in acuity following the 3 initial injections
In the setting of nonresponsiveness to Avastin and or Lucentis, Eylea injections are a prudent alternative. In this retrospective case study, our data suggests that beginning Eylea rescue therapy can lead to CNV resolution in 25% of eyes previously nonresponsive to anti-VEGF therapy. Our data at this point suggests that CNV activity is unlikely to cease if it does not do so during the initial 3 rescue injections. Also of note, the majority(70%) of eyes undergoing rescue therapy maintained or gained acuity following the 3 rescue injections.
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