Purchase this article with an account.
Sarah Cheng, Theodore Leng; Factors associated with poor response to aflibercept after switching from ranibizumab or bevacizumab in neovascular age-related macular degeneration (AMD). Invest. Ophthalmol. Vis. Sci. 2016;57(12):3336.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose: With the introduction of aflibercept as a treatment for neovascular AMD, physicians have switched patients on ranibizumab or bevacizumab who failed to improve visual acuity with the goal of a better response. While some patients improved on aflibercept, others developed worse vision. The purpose of this study was to determine factors associated with worse visual outcomes after switching.
A retrospective review was performed of 248 patients treated with aflibercept from November 2011 to August 2014. Visual acuity was examined at the time of the switch, one month, three months, and 12 months after. Patients who improved visual acuity after switching to aflibercept were compared to patients who lost vision. Spectral domain optical coherence tomography (SD-OCT) imaging was performed at the time of the switch. SD-OCT parameters such as vitreomacular adhesions, epiretinal membrane, sub-retinal fluid, intra-retinal fluid, pigment epithelium detachment, integrity of the ellipsoid zone, subretinal CNV or scar, geographic atrophy, and central cube thickness as well as central subfield thickness were used as predictors of worsening—in addition to age, gender, race, BMI, obesity (BMI>30), smoking, co-morbid conditions (hypertension, diabetes, malignancies), use of anti-inflammatory medication (bromfenac, triamcinolone acetonide), number of previous injections of ranibizumab and bevacizumab, and use of Age-Related Eye Disease Study supplements—for the analysis. Demographic and SD-OCT imaging findings were compared between responders and non-responders, using univariate (X2, Wilcoxon Rank Sum, T-Test) and multivariate (nominal logistic) analysis. Statistical significance was taken for p < 0.05 and trending significance were taken for 0.05 < p < 0.10.
Twenty-five patients (29 eyes) improved visual acuity after switching, and 21 patients (23 eyes) lost vision after the switch. Patients who lost vision had significantly higher body mass index (BMI) (p = 0.013 and rate of obesity (p=0.0014). Geographic atrophy at the switch was also identified as a significant predictor (p = 0.0381).
Higher BMI and preexisting geographic atrophy may be potential indicators for poor response to aflibercept after switching from ranibizumab or bevacizumab.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
This PDF is available to Subscribers Only