Abstract
Purpose :
To compare the efficacy of high-dose aflibercept and aflibercept for neovascular age-related macular degeneration.
Methods :
This retrospective review included age-matched neovascular age-related macular degeneration (nAMD) patients treated with aflibercept (2mg/0.05ml) and high-dose (HD) aflibercept (3mg/0.075ml). Our current clinical practice patterns are to treat nAMD eyes initially with bevacizumab and transition to aflibercept and HD aflibercept when clinically necessary. Visual acuity, central retinal thickness (CRT), qualitative optical coherence tomography (OCT) data was compared from baseline to 48 months for eyes requiring treatment with aflibercept and HD aflibercept.
Results :
A total of 200 eyes of 177 patients were included. Mean visual acuity was similar at baseline for HD aflibercept (logMAR 0.50 ± 0.46 20/63) and aflibercept groups (logMAR 0.51 ± 0.39 (20/64), p=0.20). Mean visual acuity was stable over 48 months in both HD aflibercept (logMAR 0.46 ± 0.37 (20/57), p=0.27) and aflibercept groups (logMAR 0.56 ± 0.48 (20/72), p=0.46). The HD aflibercept group started with a thicker mean CRT (313.7 ± 102.8 µm versus 276.5 ± 68.8 µm, p<0.01) and required more injections than the aflibercept group (34.8 ± 12.5 vs 27.3 ± 9.7 injections respectively, p<0.01). HD aflibercept eyes were also less likely to be extended (27% versus 45%, respectively, p<0.01). Of the 100 eyes who had an incomplete response to monthly bevacizumab and monthly aflibercept, 97% achieved a dry macula with monthly HD aflibercept. Central retinal thickness also improved in HD aflibercept (313.7 ± 102.8 µm to 264.7 ± 52.26 µm, p<0.001) and aflibercept groups (276.5 ± 68.8 µm to 231.0 ± 54.8 µm, p<0.001) over 48 months.
Conclusions :
Aflibercept and HD aflibercept are effective at maintaining visual acuity and central retinal thickness in eyes with nAMD over 48 months. Eyes with a suboptimal response to monthly bevacizumab and monthly aflibercept were able to achieve comparable visual acuity and OCT outcomes with high-dose aflibercept. Further studies are necessary to elucidate the real-world applications of standard dose and HD aflibercept.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.