July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Vision and OCT Outcomes Following 2018 Aflibercept Recall
Author Affiliations & Notes
  • Nate Benner
    College of Medicine , Larner College of Medicine at the University of Vermont , Burlington, Vermont, United States
  • Samantha D'Amico
    College of Medicine , Larner College of Medicine at the University of Vermont , Burlington, Vermont, United States
  • Brian Y Kim
    College of Medicine , Larner College of Medicine at the University of Vermont , Burlington, Vermont, United States
  • Christopher J. Brady
    College of Medicine , Larner College of Medicine at the University of Vermont , Burlington, Vermont, United States
  • Footnotes
    Commercial Relationships   Nate Benner, None; Samantha D'Amico, None; Brian Kim, Regeneron (F); Christopher Brady, Regeneron (F)
  • Footnotes
    Support  Samantha D'Amico and Nathan Benner were supported by the Elliot W Shipman Research Fund, Christopher Brady, MD was supported by NIGMS Grant P20 GM103644
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 964. doi:
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      Nate Benner, Samantha D'Amico, Brian Y Kim, Christopher J. Brady; Vision and OCT Outcomes Following 2018 Aflibercept Recall. Invest. Ophthalmol. Vis. Sci. 2019;60(9):964.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : A voluntary recall of aflibercept was instituted on 2/28/18 due to increased post-injection inflammation. At our university-based practice, affected vials were used in 320 patients without any known cases of inflammation. Bevacizumab was recommended as an alternative to aflibercept immediately following the recall. There were non-recalled lots of aflibercept available for patients who preferred not to switch. By 4/1/2018 both injecting surgeons resumed planned aflibercept injections and offered transition back from Bevacizumab. For this study we sought to characterize the impact of switching medication on visual acuity (VA) and central subfield thickness (CST) on OCT.

Methods : The charts of all patients who received recalled aflibercept were reviewed. Patients who received an intravitreal anti-VEGF injection between 3/1/18 and 4/1/18 were included in the analysis. Data on VA and CST were extracted from one pre-recall visit, one visit during the index period, and any subsequent visits until 7/2/18.

Results : During the index period, 132 injections were performed in eligible patients. Bevacizumab was used in 81 (61.4%), aflibercept was used in 49 (37.1%), and ranibizumab was used in 2 (1.5%). At the next visit (median of 47 days) 68 (84%) patients who had received Bevacizumab transitioned back to aflibercept. In both switched and maintained patients, the median change in visual acuity at the visit immediately after switching was 0 letters (p=0.253). There were several more switched patients who lost more than 10 letters as compared with the maintained group (fig. 1). The median change in CST was +3 microns for switched and -6 for maintained (p=0.085). There were likewise several more switched patients who had >50 microns increased CST as compared with maintained patients(fig. 2).

Conclusions : A voluntary recall of aflibercept allowed us to study the effect of changing anti-VEGF agent in our patients with retinal vascular disorders. Given there was no median change in vision, we felt this switch did not have an overall deleterious effect on our patients. Assuming a difference in Medicare allowable cost between the 2 medications of approximately $1900, by replacing 81 aflibercept injections with bevacizumab, $153,900 were theoretically saved by the healthcare system overall during this period. The fact that the distributions of change in vision and CST favored the group who maintained on aflibercept is worth further exploration.

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

 

 

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