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John Campbell, Robert Beardsley, Dongseok Choi, Christina Flaxel, Steven Bailey, Andreas Lauer, Thomas Hwang; Effect of anti-VEGF medication change on central macular thickness and visual acuity in patients with neovascular age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3823. doi: https://doi.org/.
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To evaluate the effect of switching anti-VEGF agents in the treatment of age-related macular degeneration.
In this retrospective case series, all patients seen in the retina department at a single academic medical center between 2007 - July 2012 who received anti-VEGF therapy for neovascular age-related macular degeneration were identified. Subjects were included if they had received at least three consecutive monthly (4 +/- 1 week) injections of the same anti-VEGF medication (bevacizumab, ranibizumab, or aflibercept) and were then switched to a second medication and continued for at least three consecutive monthly injections. Subjects were excluded if they did not have available optical coherence tomography (OCT) data, or treatment intervals were delayed beyond 5 weeks. The primary outcome was change in central macular thickness (CMT) one month post medication switch. Secondary outcomes included change in CMT at three months, change in visual acuity (VA), as well as pre-planned subgroup analyses for each anti-VEGF medication switch.
A total of 939 patients were identified who had received anti-VEGF therapy during the study period. 36 eyes (31 patients) were identified that met inclusion criteria. Mean age was 82. 58% of the patients were female. Patients had received a mean of 20 injections prior to the medication switch (median 16). In the first month after medication change, mean CMT decreased 22 uM (95% confidence interval [CI] 7 to 37 uM, P = 0.005), and at three months 27 uM (CI 12 to 43 uM, P = 0.001). Mean one month logmar VA change was 0.04 (CI 0.0 to 0.09), equivalent to a two letter ETDRS gain, compared with -0.02 (CI - 0.05 to 0.01), equivalent to a one letter mean loss in the three months prior (P = 0.038). The mean change in visual acuity persisted after three months (P = 0.023). Subgroup analysis revealed a similar trend towards improvement for all combinations of agents, however not all subgroups groups reached statistical significance for the primary outcome.
These results suggest that altering anti-VEGF agents in patients who have received multiple injections of anti-VEGF agents may provide additional short-term benefit in the OCT and visual acuity. Additional research is needed to confirm these findings, provide long-term follow-up, and compare specific anti-VEGF agent combinations.
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