June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Visual and anatomical outcomes of a fixed dosing and reduced monitoring aflibercept treatment regimen in neovascular age-related macular degeneration patients
Author Affiliations & Notes
  • Alasdair Neil Warwick
    Southampton Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
    Clinical Neurosciences Research Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
  • Hannah Leaver
    Clinical Neurosciences Research Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
  • Andrew J Lotery
    Southampton Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
    Clinical Neurosciences Research Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
  • Srini Goverdhan
    Southampton Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
    Clinical Neurosciences Research Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
  • Footnotes
    Commercial Relationships Alasdair Warwick, None; Hannah Leaver, None; Andrew Lotery, None; Srini Goverdhan, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 5352. doi:
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      Alasdair Neil Warwick, Hannah Leaver, Andrew J Lotery, Srini Goverdhan; Visual and anatomical outcomes of a fixed dosing and reduced monitoring aflibercept treatment regimen in neovascular age-related macular degeneration patients. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5352.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

Neovascular age-related macular degeneration (AMD) responds to anti-vascular endothelial growth factor treatments with aflibercept and ranibizumab. However, real life clinical outcomes using trial regimens are lacking. We performed a retrospective, observational study on outcomes for a fixed dosing aflibercept treatment regimen with reduced monitoring.

 
Methods
 

165 neovascular AMD patients (male:female = 64:101) treated with aflibercept were identified. Mean age was 81.6 years (range 60-96). These patients had either switched from previous treatment with a pro re nata (PRN) ranibizumab regimen (n=107) or were treatment naïve (n=58). A fixed dosing and reduced monitoring regimen of aflibercept was used, as outlined in figure 1. Choroidal neovascularisation (CNV) subtypes, best-corrected visual acuity (BCVA), central retinal thickness (CRT) and number of injections/clinic visits over 13 months were analysed. Wilcoxon matched-pairs signed rank test was used to compare BCVA and CRT at last follow-up to baseline.

 
Results
 

12% of patients had predominantly/minimally classic CNV (>60% patients in VIEW 1 study), while 88% had occult type CNV lesions. Mean BCVA change at month 13 was +3.28 and +4.67 letters in the switched and naïve aflibercept groups respectively (p<0.01). BCVA stabilised or improved in 85% of switched and 86% of naïve patients (table 1). CRT at month 13 showed a mean decrease of -6.16µm in the switched group and -35.36µm decrease in the naïve group (p<0.01). Mean follow-up for patients previously treated with ranibizumab was 12.6 months, receiving an average of 7.39 ranibizumab injections and attending 10 clinic visits. Treatment with the fixed dosing aflibercept regimen required 7 injections and 3 clinic visits per year.

 
Conclusions
 

Aflibercept is effective in both treatment naïve neovascular AMD patients and those resistant to previous ranibizumab treatment. Furthermore, adopting a fixed dosing regimen with reduced monitoring required considerably fewer clinic appointments than PRN dosing, saving valuable healthcare resources.  

 
Figure 1. Southampton Eye Unit year 1 aflibercept treatment pathway
 
Figure 1. Southampton Eye Unit year 1 aflibercept treatment pathway
 
 
Table 1. Mean Early Treatment Diabetic Retinopathy Study (ETDRS) letter gain and proportion of ETDRS letters gained for switched and naïve aflibercept treatment groups
 
Table 1. Mean Early Treatment Diabetic Retinopathy Study (ETDRS) letter gain and proportion of ETDRS letters gained for switched and naïve aflibercept treatment groups

 
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