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Papp András, Bernd Sommerauer, Olaf Sowade, VIEW investigators; Comparison of Treatment Schedules in an Integrated Analysis of the VIEW Studies. Invest. Ophthalmol. Vis. Sci. 2013;54(15):6271.
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© ARVO (1962-2015); The Authors (2016-present)
To compare intravitreal aflibercept injection (IAI) treatment schedules by functional outcomes in an integrated analysis of the 2 phase 3 VIEW studies.
Patients with neovascular age-related macular degeneration (n=2412) were randomized to monthly ranibizumab 0.5 mg (Rq4), monthly IAI 2 mg (2q4), monthly IAI 0.5 mg (0.5q4), or IAI 2 mg every-other-month (2q8) following 3 initial monthly doses. The primary endpoint, proportion of patients losing <15 Early Treatment Diabetic Retinopathy Study letters, and key secondary endpoints were evaluated at Week 52. Between Weeks 52-96, injections were given at 12-week intervals, but could be given more frequently (up to every 4 weeks) if pre-specified criteria were met. Subgroup analyses were performed post-hoc.
At both 52 and 96 weeks, treatment outcomes were similar for groups who received monthly or every-other-month treatment through Week 52 (Table). At 52 weeks, quartile analysis of visual acuity changes (<1, 1 to <6, 6 to <13, and ≥13 letters) showed comparable results for all dosing groups. At week 96, for all groups a slight, overall trend of vision loss was observed with reactive dosing (mean injections 4.1-4.7) compared to the results after 52-weeks of proactive dosing. During Weeks 52-96, visual acuity outcomes were maintained for the subgroup of patients who only received the 3 mandatory doses (~40-50% of patients in each dosing group). The incidence of ocular and systemic adverse events (AEs) was balanced across treatment groups in the overall population. The most frequent ocular AEs (>10% of patients) were conjunctival hemorrhage, eye pain, retinal hemorrhage, and reduced visual acuity.
These results show similar efficacy for monthly and every-other-month dosing with IAI across subgroups. Generally, a proactive treatment approach leads to more stable visual acuity results than reactive treatment.
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