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Intravitreal ranibizumab versus aflibercept following treat and extend protocol for neovascular age-related macular degeneration

  • Retinal Disorders
  • Published:
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Abstract

Purpose

To assess the morphological and functional outcome and stability of the “treat and extend” protocol using aflibercept compared to ranibizumab for the treatment of eyes with neovascular age-related macular degeneration.

Patients and methods

This retrospective study included 100 eyes of 94 patients with primary onset neovascular age-related macular degeneration followed up for 12 months. We studied two groups of eyes: group 1, 50 eyes treated with 0.5 mg/0.05 mL ranibizumab and group 2, 50 eyes treated with 2.0 mg/0.05 mL aflibercept. During the first year, all eyes received 3 aflibercept or ranibizumab injections monthly as upload phase. Then, eyes were treated with a treat and extend algorithm. Main outcome measures included: best corrected visual acuity (BCVA), central macular thickness (CMT), and the number of injections. In addition, we compared recurrence rates between the two groups.

Results

BCVA (log MAR) in group 1 vs group 2 was 0.54 ± 0.31 vs 0.49 ± 0.30 (p = 0.38) before treatment and 0.49 ± 0.33 vs 0.47 ± 0.32 (p = 0.85) after treatment. The visual improvement (decimal) was 0.05 ± 0.13 vs 0.04 ± 0.12 (p = 0.91). CMT in group 1 vs group 2 was 375.6 ± 98.3 μm vs 369.6 ± 103.7 μm (p = 0.73) before treatment and 306.3 ± 71.8 μm vs 294.8 ± 96 μm (p = 0.54) after treatment. The decrease in CMT was 69.3 ± 93 μm vs 74.8 ± 96 μm (p = 0.77). The number of injections/eye after upload phase in group 1 vs group 2 was 5.88 ± 1.4 vs 6.16 ± 1.3 (p = 0.25). Finally, major recurrence rates were statistically significantly different between the two groups (2% vs 6%, p = 0.04).

Conclusions

Significant differences regarding BCVA, central macular thickness, and the number of injections were not found between aflibercept and ranibizumab during the first year following the treat and extend protocol. However, the significantly higher major recurrence rates in the aflibercept group after extending the treatment interval to 10 weeks might suggest that aflibercept should better not to be used in longer than 8 weeks intervals during the first year of treatment.

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References

  1. Schmidt-Erfurth U, Chong V, Loewenstein A et al (2014) Guidelines for the management of neovascular age-related macular degeneration by the European Society of Retina Specialists (EURETINA). Br J Ophthalmol 98:1144–1167

    Article  PubMed  PubMed Central  Google Scholar 

  2. Augustin AJ, Kirchhof J (2014) Inflammation and the pathogenesis of age-related macular degeneration. Expert Opin Ther Targets 13:641–651

    Article  Google Scholar 

  3. Ferrara N, Gerber HP, Le Couter J (2003) The biology of VEGF and its receptors. Nat Med 9:669–676

    Article  CAS  Google Scholar 

  4. Jeng KW, Wilgucki J, Halperin S et al (2014) Retina specialists treating age-related macular degeneration recommend different approaches for patients than they would choose for themselves. Retina 34:1796–1801

    Article  PubMed  Google Scholar 

  5. Ferrara N, Damico L, Shams N, Lowman H, Kim R (2006) Development of ranibizumab, an anti-vascular endothelial growth factor antigen binding fragment, as therapy for neovascular age-related macular degeneration. Retina 26:859–870

    Article  Google Scholar 

  6. Stewart MW, Grippon S, Kirkpatrick P (2012) Aflibercept. Nat Rev Drug Discov 11:269–270

    Article  CAS  PubMed  Google Scholar 

  7. Schmidt-Erfurth U, Kaiser PK, Korobelnik JF et al (2014) Intravitreal aflibercept injection for neovascular age-related macular degeneration: ninety-six-week results of the VIEW studies. Ophthalmology 121:193–201

    Article  PubMed  Google Scholar 

  8. Spaide R (2007) Ranibizumab according to need: a treatment for age-related macular degeneration. Am J Ophthalmol 143:679–680

    Article  PubMed  Google Scholar 

  9. Freund KB, Korobelnik JF, Devenyi R et al (2015) Treat-and-extend regimens with anti-VEGF agents in retinal diseases: a literature review and consensus recommendations. Retina 35:1489–1506

    Article  CAS  PubMed  Google Scholar 

  10. Chakravarthy U, Harding SP, Rogers CA et al (2012) Ranibizumab versus bevacizumab to treat neovascular age-related macular degeneration: one-year findings from the IVAN randomized trial. Ophthalmology 119:1399–1411

    Article  PubMed  Google Scholar 

  11. Holz FG, Tadayoni R, Beatty S et al (2015) Multi-country real-life experience of anti-vascular endothelial growth factor therapy for wet age-related macular degeneration. Br J Ophthalmol 99:220–226

    Article  Google Scholar 

  12. Mantel I, Deli A, Iglesias K, Ambresin A (2013) Prospective study evaluating the predictability of need for retreatment with intravitreal ranibizumab for age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 251:697–704

    Article  CAS  PubMed  Google Scholar 

  13. Abdin AD, Suffo S, Bischoff-Jung M, Daas L, Pattmöller M, Seitz B (2019) [Advantages of a designated IVI center for a  German university eye hospital]. Ophthalmologe. [E-pub ahead of print]. https://doi.org/10.1007/s00347-019-0911-5

  14. Berg K, Pedersen TR, Sandvik L, Bragadóttir R (2015) Comparison of ranibizumab and bevacizumab for neovascular age-related macular degeneration according to LUCAS treat-and-extend protocol. Ophthalmology 122:146–152

    Article  PubMed  Google Scholar 

  15. Rayess N, Houston SK III, Gupta OP et al (2015) Treatment outcomes after 3 years in neovascular age-related macular degeneration using a treat-and-extend regimen. Am J Ophthalmol 159:3–8

    Article  PubMed  Google Scholar 

  16. Rush RB, Simunovic MP, Vandiver L et al (2014) Treat-and-extend bevacizumab for neovascular age-related macular degeneration: the importance of baseline characteristics. Retina 34:846–852

    Article  CAS  PubMed  Google Scholar 

  17. Lad EM, Hammill BG, Qualls LG et al (2014) Anti-VEGF treatment patterns for neovascular age-related macular degeneration among medicare beneficiaries. Am J Ophthalmol 158:537–543

    Article  CAS  PubMed  Google Scholar 

  18. Rasmussen A, Bloch SB, Fuchs J et al (2013) A 4-year longitudinal study of 555 patients treated with ranibizumab for neovascular age-related macular degeneration. Ophthalmology 120:2630–2636

    Article  PubMed  Google Scholar 

  19. Gillies MC, Nguyen V, Daien V et al (2016) Twelve-month outcomes of ranibizumab vs. aflibercept for neovascular age-related macular degeneration: data from an observational study. Ophthalmology 123:2545–2553

    Article  PubMed  Google Scholar 

  20. Stewart MW, Rosenfeld PJ (2008) Predicted biological activity of intravitreal VEGF trap. Br J Ophthalmol 92:667–668

    Article  CAS  PubMed  Google Scholar 

  21. Stewart MW (2012) Clinical and differential utility of VEGF inhibitors in wet age-related macular degeneration: focus on aflibercept. Clin Ophthalmol 6:1175–1186

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Stewart MW (2014) Pharmacokinetics, pharmacodynamics and pre-clinical characteristics of ophthalmic drugs that bind VEGF. Expert Rev Clin Pharmacol 7:167–180

    Article  CAS  PubMed  Google Scholar 

  23. Heier JS, Brown DM, Chong V et al (2012) Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration. Ophthalmology 119:2537–2548

    Article  Google Scholar 

  24. Beck RW, Moke PS, Turpin AH et al (2003) A computerized method of visual acuity testing: adaptation of the early treatment of diabetic retinopathy study testing protocol. Am J Ophthalmol 135:194–205

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology, Saarland University Medical Center UKS, KirrbergerStrasse 100, Bldg. 22, 66421, Homburg, Saar, Germany

    Alaa Din Abdin, Shady Suffo, Fatima Asi & Berthold Seitz

  2. Institute of Experimental Ophthalmology, Saarland University, Homburg, Saar, Germany

    Achim Langenbucher

Authors
  1. Alaa Din Abdin
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  2. Shady Suffo
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  3. Fatima Asi
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  4. Achim Langenbucher
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  5. Berthold Seitz
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Correspondence to Alaa Din Abdin.

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Abdin, A.D., Suffo, S., Asi, F. et al. Intravitreal ranibizumab versus aflibercept following treat and extend protocol for neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 257, 1671–1677 (2019). https://doi.org/10.1007/s00417-019-04360-9

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  • DOI: https://doi.org/10.1007/s00417-019-04360-9

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