Ranibizumab and Aflibercept: Baseline and 12-month visual outcomes of patients at a large tertiary ophthalmic hospital

Abstract

Purpose : When aflibercept received FDA approval in 2011 for neovascular age-related macular degeneration (nAMD), many patients were commenced with this treatment on a fixed dosing in the first year (as per the posology), followed by a treat and extend regimen. Previously, ranibizumab was the only licensed drug to treat this condition, the most common regimen being pro re nata after 3 loading injections (each a month apart). In this retrospective study, we compare baseline and 12 month visual acuity outcomes for the respective agents.

Methods : The Moorfields Eye Hospital Electronic Medical Record system was queried for patients who had received intravitreal anti-VEGF injections for nAMD for 12 months or more between 2008 and 2017. This was stratified into eyes having received either only ranibizumab or only aflibercept throughout the course. Baseline and 12 month visual acuity was recorded in ETDRS letters. Statistical analysis was carried out using SPSS version 23.

Results : A total of 989 and 1425 eyes had received treatment for 12 months or more with ranibizumab and aflibercept respectively. Mean year of first presentation for patients under ranibizumab was 2010 and for aflibercept 2014 while age distribution was similar (mean 79 years for both groups). Mean (±SD) baseline visual acuity for the eyes receiving ranibizumab was 54.89 (±15) letters with a gain of 2.55 letters after 12 months. Mean baseline visual acuity for the eyes receiving aflibercept was 57.05 (±16) letters with a gain of 5.93 letters at 12 months. Mean number of injections during the first year was 6 (±2) for ranibizumab and 8 (±1) for aflibercept.

Conclusions : Although baseline visual acuity was lower for the patients who received ranibizumab, the mean letter gain after 12 months was greater for the patients receiving aflibercept. This may be related to the treatment regimen i.e. pro re nata versus fixed dosing resulting in more injections in the aflibercept group in addition to differences in the drug. Further data and analysis is required to determine any longer-term differences in visual acuity taking into account posology and baseline characteristics.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.