Short-Term Outcomes of Eyes with Neovascular Age-related Macular Degeneration (nAMD) that Switched from Aflibercept to Ranibizumab

Abstract

Purpose : To describe short-term outcomes of eyes with nAMD that were switched from aflibercept to ranibizumab.

Methods : A retrospective review of eyes with nAMD that received ≥3 consecutive aflibercept injections before switching to ranibizumab was performed. Cases were identified that were switched between January 2018-April 2018 due to reports of intraocular inflammation with aflibercept. Seven timepoints were gathered: 3 (B3), 2 (B2), and 1 (B1) visit before the switch, the switch visit (Sw), and visit 1 (P1), 2 (P2), and 3 (P3) post-switch. Eyes were excluded if intervals between B2 – B1 and B1 – Sw were >7 days apart or if the injection interval increased post-switch (Sw – P1 > B1 – Sw). Statistical tests were performed using SPSS, Version 24 (SPSS, Inc, Chicago, Illinois, USA). Generalized estimating equation was used for outcome comparisons to account for intercorrelation between eyes from the same patient. Statistical significance was defined as p<0.05.

Results : 148 eyes of 120 patients were eligible for analysis. Eyes received a mean of 20.7 aflibercept injections prior to switching. The mean number of days between each timepoint is shown in Figure 1. Comparing VA from B3, B2, or B1 (all 0.48 logMAR, ~20/60 Snellen) to Sw (0.47 logMAR, ~20/60 Snellen), there was no significant change. VA decreased at P1 (0.51 logMAR, ~20/65 Snellen) when compared to Sw (p=0.07). For eyes continuing ranibizumab at P1 (n=126), VA decreased at P2 (0.54 logMAR, ~20/70 Snellen) compared to Sw (p=0.02). For eyes that received ranibizumab at P2 (n=98), VA decreased at P3 (0.52 logMAR, ~20/66 Snellen) when compared to Sw (p=0.20). Comparing mean CFT from B3 (191 µm), B2 (188 µm), and B1 (181 µm) to Sw (186 µm), there was no significant change. Mean CFT significantly increased to 198 µm at P1 when compared to Sw (p=0.004). For eyes that continued on ranibizumab at P1, mean CFT increased to 193 µm at P2 when compared to Sw (p=0.001). For eyes that received ranibizumab at P2, mean CFT increased to 194 µm at the P3 visit when compared to the switch visit (p=0.01).

Conclusions : Our study found worsening of functional and anatomic outcomes in eyes with nAMD that switched from aflibercept to ranibizumab despite shorter mean injection intervals post-switch, suggesting at least a slight short-term difference in clinical efficacy and duration of effect.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

Figure 1