RANIBIZUMAB VERSUS AFLIBERCEPT FOR THE TREATMENT OF PIGMENT EPITHELIAL DETACHMENT IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: DATA FROM A PROSPECTIVE OBSERVATIONAL STUDY

Abstract

Purpose : The aim was to compare the efficacy of intravitreal ranibizumab with the efficacy of intravitreal aflibercept on resolution of retinal pigment epithelium detachment (RPED) in patients with neovascular age-related macular degeneration (nAMD) six months after start of intravitreal therapy.

Methods : This was a prospective observational registry study of treatment-naïve patients with nAMD that started treatment with either aflibercept or ranibizumab on or after 1st October 2013. Inclusion criteria were presence of RPED defined as “any separation of RPE from Bruch’s membrane as seen on spectral domain optical coherence tomography (SD-OCT)” that was not secondary to drusen at baseline, presence of follow up OCT scan on or after 22 weeks and eyes having mono-therapy with either aflibercept or ranibizumab throughout six months. The assessment was done by an independent reading center masked to the treatment arms. Maximum RPED dimensions at baseline and after 6 months of treatment were evaluated on either Spectralis (Heidelberg Engineering) or Cirrus (Carl Zeiss Meditec) devices. RPEDs were graded as hollow, solid or mixed based on their SD-OCT reflectivity at baseline and were also classified into subfoveal, juxtafoveal or extrafoveal. Treatments were recorded for each visit.

Results : We identified 233 eligible eyes, 97 out of the 233 (42%) had RPEDs. Patients treated with ranibizumab were significantly older than aflibercept treated patients (84.1 vs. 78.2 years, P < 0.001). Patients treated with aflibercept had a larger maximum RPED diameter (2171.9µm) compared to ranibizumab (1734.2µm, P = 0.033), although maximum RPED height was similar between the two groups (215.9µm for ranibizumab vs. 254.4µm for aflibercept, P = 0.175). There were more extrafoveal and juxtafoveal RPEDs in ranibizumab treated patients, while aflibercept treated patients had more subfoveal RPEDs (P = 0.047). The mean change (95% CI) in max RPED height at 6 months was -97.1µm (-135.0, -59.2) for ranibizumab and -105.7µm (-148.7, -62.8) for aflibercept (P = 0.642). Injection frequency was the only clinical variable to have a significant impact on RPED height.

Conclusions : Treatment-naïve patients with nAMD and RPED showed significant anatomical improvement at 6 months with both intravitreal ranibizumab or aflibercept injections in clinical routine pratice.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.