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Manuel Amador, Mahima Jhingan, Amit Meshi, Kunny Dans, Tiezhu Lin, Melina Cavichini Cordeiro, William R Freeman; High-Dose High-Frequency Aflibercept For Recalcitrant Neovascular Age-Related Macular Degeneration (2-year follow up). Invest. Ophthalmol. Vis. Sci. 2019;60(9):112.
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To evaluate the efficacy of monthly (0.1 mL/4 mg) aflibercept for refractory wet age-related macular degeneration (AMD) after 2 years.
This was a retrospective interventional case series. Patients with wet AMD were treated with stepwise dose escalation. Patients resistant to monthly ranibizumab/bevacizumab 2 mg were switched to aflibercept every 8 weeks. With resistance, they were escalated to every 4 weeks 2 mg aflibercept, and if resistance persisted, they were escalated to 4 mg (4Q4W) aflibercept. Resistance was defined as 2 recurrences after being dry following 3 injections or persistent exudation after 5 injections.
Twenty five non-vitrectomized patients (30 eyes) were analyzed. The mean age was 81 years (range 68-97). The total mean duration of follow-up since the first intravitreal injection was 59 months (range 8.25-145), of which 24.5 months (range 4-55) were on 4Q4W. After starting 4Q4W, the mean number of injections required until complete fluid reabsorption was 2.7 (1-9). Mean time to achieve first dry was 2.3(0.87-8.13) months (Figure 1) and mean time to recur was 3.75 (2.33-7.93) months (Figure 2). Age, sex, CNV type and lesion size were not found to be associated with recurrence of exudation (P>0.05) (Table 1)
After 2 years, Intravitreal high-dose high-frequency aflibercept remains being an effective and safe treatment for patients with refractory wet AMD. Doubling the dose produces a rapid and sustained response and attempts to stop uniformly fail.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
Figure 1. Time to first dry after aflibercept high dose high frequency; Figure 2. Time to first recurrence after treatment holiday (months)
Cox Regression Analysis for Time to Recurrence in Treated Eyes
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