Short-term results of the switchback from aflibercept to ranibizumab in neovascular age-related macular degeneration

Abstract

Purpose: Several studies have documented the switch from ranibizumab to aflibercept in patients with refractory choroidal neovascularization due to neovascular age-related macular degeneration (nAMD). In case of limited results of the switch, some patients may be switched back to the initially prescribed drug. We conducted a retrospective study to determine the short-term efficacy of switching back from aflibercept to ranibizumab in nAMD patients previously switched from ranibizumab to aflibercept.

Methods: Double-center retrospective study of 47 eyes of 45 nAMD patients first treated with ranibizumab then aflibercept and retreated with ranibizumab was performed. Primary outcome was changes in best-corrected visual acuity (BCVA) measured using the ETDRS chart before (T0) and after (T1) switching, and three months after switching back (T2). Secondary outcomes were changes in central foveal thickness (CFT) on SD-OCT between T0, T1 and T2, and percentage of patients who gained ≥ 5 letters.

Results: Mean BCVA was 67.4±13.4 at T0, 66.7±14.4 at T1, and 68.2±13.9 at T2. BCVA significantly improved between T1 and T2 (p=0.02), but not between T0 and T1 (p=0.51) and T0 and T2 (p=0.42). Mean CFT decreased from 317.8±89.6 μm at T0 to 306.9±68.0 μm at T1<br /> and 291.2±76.6 μm at T2. CFT did not significantly decrease between T0 and T1 and T1 and T2, but significantly decreased between T0 and T2 (p=0.002). Thirteen eyes gained ≥ 5 letters after switching back.

Conclusions: Switching back from aflibercept to ranibizumab resulted in short-term benefits in nAMD patients for whom switching from ranibizumab to aflibercept was weakly effective.