Effects of Switching from Ranibizumab to Aflibercept on Visual Outcome, Lesion Activity and Treatment Intensity in Eyes with Neovascular Age-Related Macular Degeneration

Abstract

Purpose: To evaluate the effect of changing from ranibizumab to aflibercept in eyes with neovascular age-related macular degeneration (nAMD) on visual acuity, lesion activity and the interval of time between treatments.

Methods: Observational longitudinal study using anonymized data from patients treated for nAMD. Visual acuity (VA) was recorded at each visit using the logarithm of the Minimum Angle of Resolution (logMAR) letter score. For each treated eye an index visit was defined as the visit when treatment for nAMD was commenced. Visual acuity, lesion activity and treatment given were recorded for each follow-up visit. Decision to treat was made by the treating physician, thus reflecting daily clinical practice. Only eyes with nAMD that changed from ranibizumab to aflibercept treatment were included. Eyes that switched treatments were required to have been on the original treatment for at least 12 months, and then followed for an additional 12 months post treatment switch. We compared VA at the time of the switch with VA 12 months after treatment change, and compared the treatment intensity and lesion activity in the 12 months before and the 12 months after the switch.

Results: A total of 381 eyes were analyzed. The mean VA at the time treatment was switched was 64.4 logMAR letters, mean VA 12 months later was 63.8 logMAR letters. The difference was statistically not different. Prior to treatment change eyes received more injections compared with after: there was a mean of 8.1 treatments within 12 months prior to switch, this reduced to 7.4 injections in 12 months post switch (p<0.001). There was a significant decrease in the proportion of CNV activity of switching eyes: at the point of treatment change 78% of eyes had an active CNV reading, after 12 months this proportion had dropped to 55% (p<0.001).

Conclusions: Changing from ranibizumab to aflibercept treatment in nAMD may result in a reduced treatment load in<br /> some eyes. However the influence of the additional time under treatment on overall treatment load warrants further investigation.