Purchase this article with an account.
Luke Michaels, Hussein Almuhtaseb, Adham Youssef, Christina A Rennie, Andrew J Lotery; Twenty Four-Month Outcomes of Aflibercept for Neovascular Age-Related Macular Degeneration: Different Treatment Regimens in Year Two based on the Macular Status at the End of Year One. Invest. Ophthalmol. Vis. Sci. 2017;58(8):433.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To compare clinical outcomes in year 2 of treatment with aflibercept for eyes with neovascular age-related macular degeneration (nAMD).
A single centre retrospective analysis from an electronic medical record system identified 105 treatment-naïve eyes with nAMD that completed 2 years of treatment with aflibercept..In year 1 (Y1), eyes were treated per VIEW study protocol. At end of Y1, eyes were classified into Inactive-Dry or Active-Wet based on evidence of exudation and were assigned to 3 treatment regimens in Y2.Wet Maculae received intravitreal injections (IVIs) bi-monthly (Q8W) with only 2 follow-up visits at months 17 and 23 [GROUP A] (n=30). Dry Maculae received aflibercept in 2 ways: Capped PRN: bi-monthly OCTs with mandatory “capped” IVIs at an interval of 12 weeks since the previous treatment [GROUP B] (n=25) or by Treat and Extend (T&E) [GROUP C] (n=23). In a seperate subgroup of wet maculae, aflibercept was administered at a greater frequency Q6W/Q4W in Y2 [GROUP D] (n=27).Mean change in best corrected visual acuity (BCVA) and central retinal thickness (CRT) at Y2 compared to Y1 and to baseline, mean number of injections and of follow-up visits in Y2 were assessed.
Mean LogMar BCVA and CRT of GROUPS A-C were comparable at baseline. The mean LogMar BCVA of GROUPS A-C improved to 0.45 [+9 ETDRS L gain], 0.54 [+6 ETDRS L gain] and 0.50 [+7 ETDRS L gain] respectively at the end of Y1.Mean LogMar BCVA of GROUPS A-C were 0.4 [+3 ETDRS L gain], 0.54 [maintained VA gain] and 0.50 [maintained VA gain] respectively at the end of Y2.Mean LogMar BCVA of GROUP D pre- and post-switch into aflibercept Q6W/Q4W was 0.40 and 0.44 respectively (P=0.4). Mean CRT pre- and post-switch was 210 and 229 (P=0.11) respectively.The average number of IVIs in Y2 was 6, 4 and 5 in GROUPS A-C respectively.The average number of Clinic Visits in Y2 was 2, 6 and 5 in GROUPS A-C respectively.
Gains at the end of Y1 were maintained throughout the 2-year treatment plan in all treated groups. Q8W, CPRN and T&E are proactive regimens that appear to guarantee maintainance of Y1 gains. Shortening the inter-IVI interval down to Q6W/Q4W might not guarantee better clinical outcomes. Aflibercept Q8W in Y2 is a cost-effective treatment regimen as it maintains Y1 gains with the lowest number of follow-up visits.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
This PDF is available to Subscribers Only