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Khushboo Agrawal, Rachel Chen, Shaun Ittiara, Ravi Patel, Seenu Hariprasad; Comparison of the Relative Efficacy of Aflibercept in the Treatment of Neovascular Age Related Macular Degeneration in Patients Previously Treated with Alternative Vascular Endothelial Growth Factor Inhibitors. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3828.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the efficacy of Aflibercept in the treatment of neovascular age related macular degeneration (ARMD) in patients who have been treated previously with alternative vascular endothelial growth factor (VEGF) inhibitors. We intend to provide an analysis based not only on efficacy, but also on patient satisfaction and impact on quality of life.
IRB approved, prospective cohort study of 35 eyes of 29 patients who switched from prior VEGF therapy (Pegaptanib, Bevacizumab, and/or Ranibizumab) to Aflibercept between February and December of 2012. Each patient received Aflibercept 2 mg per the FDA approved regimen. Each patient was also asked to complete the Visual Functioning Questionnaire (VFQ-25) at baseline and subsequent predetermined intervals during treatment.
Mean patient age was 81.6 years. 16 of 29 patients were male. Mean pretreatment (prior to switchover to Aflibercept) logarithmic of the minimum angle of resolution visual acuity (Log MAR VA) was 0.978 (20/189) with a range of 0.1 to 2.6. Mean post treatment Log MAR VA was 0.93 (20/169; p = 0.68) after the first Aflibercept injection and 0.68 (20/96; p = 0.09) after the second Aflibercept injection. Mean pretreatment CMT was 288 microns; mean post treatment CMT was 261 microns after the 1st Aflibercept injection (p = 0.06), and 271 microns after the 2nd Aflibercept injection (p = 0.3). Analysis of the VFQ-25 answers revealed a trend towards improvement in general vision, near tasks, mental health, and reduced dependency from baseline treatment to three months following initial Aflibercept injection.
Since it gained FDA approval in 2011 for neovascular ARMD, Aflibercept has expanded the treatment options for this debilitating condition. Our findings suggest that in patients who have previously been treated with alternative VEGF inhibitors, there is a trend towards improvement in visual acuity, CMT, and, perhaps most importantly, quality of life. This can partly be explained by tachyphylaxis which develops in this cohort of patients. Further follow up of these patients is warranted to understand fully the relative efficacy of Aflibercept in neovascular ARMD.
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