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Cheryl A Arcinue, Feiyan Ma, Giulio Barteselli, Lucie Sharpsten, Aubrey Doede, Maria Laura Gomez, William R Freeman; Six-Month Outcomes of Aflibercept in Recurrent or Persistent Neovascular Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3927.
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To evaluate the short-term outcomes of every 8 weeks (Q8W) intravitreal aflibercept (IA) in patients that developed resistance to every 4 weeks (Q4W) ranibizumab or bevacizumab (R/B).
This was a consecutive case series of patients who developed resistance to Q4W R/B, and were switched to Q8W IA. Resistance was defined as having multiple recurrences or persistence of exudation. All eyes received a minimum of three Q8W IA and had a minimum of 6 months follow-up after the first IA.
There were 44 eyes of 39 patients, with a mean age of 81 years (range, 67-90) at the time of switching. Eyes received a mean of 18 (range, 5-40) previous R/B. There were 19 eyes that had multiple recurrences and 25 eyes that had persistent fluid. The mean duration between the last R/B and the first IA was 10.7 weeks (range, 3-25). Among the eyes that had multiple recurrences, the mean duration when the eyes first became dry was 16.3 weeks (after the last cycle of R/B) compared with 6.4 weeks (after the first cycle of IA) (p=0.008). Out of the 25 eyes that had persistent fluid, the mean duration when the eyes first became dry was 13.4 weeks (range, 3.6-24.7). One month after the first IA, 82% (36 eyes) showed excellent to complete anatomic response, which was maintained in 61% (27 eyes) two months after the first injection (p=0.003). The 6-month follow-up visit took place at an average of 24.4 weeks (range, 20.6-27.9). One month after the third Q8W IA, 93% (41 eyes) had excellent to complete response, but this was sustained in only 66% (n=29) of eyes 2 months after the third injection (p=0.034). The anatomic response rates were significantly better after the third IA compared with the first IA, both at 1 month (p=0.004) and 2 months (p<0.001). The mean maximum retinal thickness (MRT) improved from 377 to 250 um at 6 months (p<0.001). However, there was no significant improvement in ETDRS visual acuity (VA) (p=0.087), but there was an overall weak trend towards improved VA (slope of 0.002; 95% CI -0.0006 to 0.005) (p=0.12).
Two-thirds of eyes with recurrent or persistent exudation while on Q4W R/B had excellent to complete anatomic response after changing to Q8W IA at 6 months. Although VA did not significantly improve, there was a trend towards improved VA at 6 months. Longer-term follow-up might be needed to see visual gains.
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