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Mehmet Ozturk, Martin Harris, Vuong Nguyen, Daniel Barthelmes, Mark C Gillies, Hemal Mehta; Real-world visual outcomes in patients with neovascular age-related macular degeneration receiving aflibercept (Eylea) intravitreal injections at fixed intervals as per UK license. Invest. Ophthalmol. Vis. Sci. 2017;58(8):881.
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© ARVO (1962-2015); The Authors (2016-present)
We tested the hypothesis that those patients receiving fewer than the mandated 8 injections in the first year of treatment with intravitreal aflibercept as per UK license would experience worse visual outcomes.
We performed a retrospective, single-centre observational study of all treatment naïve patients receiving aflibercept for at least one year (n=42 eyes). Fight Retinal Blindness! software was used for the first time in the UK to measure real-world outcomes. We assessed visual acuity (VA) outcomes at one year between patients who had received the recommended 8 or more injections (n=22) and those receiving 7 or fewer injections (n=20). Analysis was performed using 2 sample t-tests. P<0.05 was considered statistically significant. We also retrospectively analysed patient case notes to ascertain reasons for under treatment.
Within-group VA change (95% CI) at 12 months was significant for eyes receiving 8 or more injections (+6.0 letters [0.8, 11.1], p = 0.026) but not for eyes receiving fewer than 8 injections (+2.7 letters [-1.5, 7.0], p = 0.196). The mean +6.0 letter gain at 1 year in those adequately treated is similar to +8.4 letters gained in the integrated analysis of the VIEW 1 and VIEW 2 phase 3 clinical trials on which the UK license is based. Eyes with lower baseline VA have more potential to gain VA compared to those with higher baseline VA. This effect was not observed in the “undertreated” group. The main reasons for patients being undertreated were insufficient clinic capacity and non-attendance due to illness.
Patients receiving intravitreal aflibercept injections for neovascular age-related macular degeneration at fixed treatment intervals as per the UK licence had similar visual improvement at one year compared with seminal phase III clinical trials. However, undertreated patients had worse visual outcomes. Measures need to be introduced to improve clinic capacity and closely follow non-attenders to prevent under treatment and improve future outcomes.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Table 1: Comparison of demographics and visual acuity outcomes of eyes receiving less than 8 injections within first year of treatment vs. eyes receiving 8 or more injections.
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