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Short-term results of switchback from aflibercept to ranibizumab in neovascular age-related macular degeneration in clinical practice

  • Retinal Disorders
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Abstract

Purpose

This work was undertaken to analyze the efficacy of switchback from aflibercept to ranibizumab in patients with neovascular age-related macular degeneration (nAMD) who had previously switched from ranibizumab to aflibercept.

Methods

This retrospective double-center study included 45 patients with nAMD who were previously treated with ranibizumab, then aflibercept, and then ranibizumab again, regardless of the number of intravitreal injections received. The primary outcome was change in best-corrected visual acuity (BCVA) measured on the Early Treatment Diabetic Retinopathy Study ETDRS chart before (T0) and after (T1) the switch, and 3 months after the switchback (T2). Secondary outcomes included changes in central foveal thickness (CFT) measured at T0, T1, and T2, as analyzed on spectral-domain optical coherence tomography (SD-OCT), and the percentage of patients gaining five letters or better.

Results

Forty-seven eyes of 45 patients were switched back from aflibercept to ranibizumab. The mean BCVA was 67.4 ± 13.4 at T0, 66.7 ± 14.4 at T1, and 68.2 ± 13.9 at T2. BCVA was significantly improved between T1 and T2 (p = 0.0230), but not between T0 and T1 (p = 0.5153) or between T0 and T2 (p = 0.4248). The mean CFT decreased from 317.8 μm ± 89.6 at T0 to 306.9 μm ±68.0 at T1, and to 291.2 μm ± 76.6 at T2. The decrease in CFT was not statistically significant between either T0 and T1 or T1 and T2, but was significant between T0 and T2, when compared before switch and after switchback (p = 0.0027). However, when considering eyes that received three or more consecutive intravitreal injections of aflibercept before switchback, the statistical significance between T1 and T2 was lost, although a trend towards significance remained (p = 0.06). Thirteen eyes (27.7 %) gained five letters or more (range, 5–15 letters) after switchback.

Conclusions

A short-term benefit of switchback from one anti-VEGF agent to another was observed in patients with nAMD who had shown no benefit from the initial switch.

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References

  1. Hubschman JP, Reddy S, Schwartz SD (2009) Age-related macular degeneration: current treatments. Clin Ophthalmol 3:155–166

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. ANAES report (2012) Dégénérescence maculaire liée à l’âge: prise en charge diagnostique et thérapeutique. Available at: http://www.has-sante.fr/portail/upload/docs/application/pdf/2012-12/reco2clics_degenerescence_maculaire_liee_a_lage_prise_en_charge_diagnostique_et_therapeutique_2012-12-10_15-25-41_878.pdf. Accessed 5 March 2015

  3. Holz FG, Bandello F, Gillies M, Mitchell P, Osborne A, Sheidow T, Souied E, Figueroa MS, LUMINOUS Steering Committee (2013) Safety of ranibizumab in routine clinical practice: 1-year retrospective pooled analysis of four European neovascular AMD registries within the LUMINOUS programme. Br J Ophthalmol 97:1161–1167

    Article  PubMed  PubMed Central  Google Scholar 

  4. Cohen S-Y, Souied EH, Weber M, Dupeyron G, de Pouvourville G, Lievre M, Ponthieux A (2011) Patient characteristics and treatment of neovascular age-related macular degeneration in France: the LUEUR1 observational study. Graefes Arch Clin Exp Ophthalmol 249:521–527

    Article  PubMed  Google Scholar 

  5. Forooghian F, Cukras C, Meyerle CB, Chew EY, Wong WT (2009) Tachyphylaxis after intravitreal bevacizumab for exudative age-related macular degeneration. Retina 29:723–731

    Article  PubMed  PubMed Central  Google Scholar 

  6. Messenger WB, Campbell JP, Faridi A, Shippey L, Bailey ST, Lauer AK, Flaxel CJ, Hwang TS (2014) Injection frequency and anatomic outcomes 1 year following conversion to aflibercept in patients with neovascular age-related macular degeneration. Br J Ophthalmol 98:1205–1207

    Article  PubMed  Google Scholar 

  7. Bakall B, Folk JC, Boldt HC, Sohn EH, Stone EM, Russell SR, Mahajan VB (2013) Aflibercept therapy for exudative age-related macular degeneration resistant to bevacizumab and ranibizumab. Am J Ophthalmol 156:15–22

    Article  CAS  PubMed  Google Scholar 

  8. Ho VY, Yeh S, Olsen TW, Bergstrom CS, Yan J, Cribbs BE, Hubbard GB 3rd (2013) Short-term outcomes of aflibercept for neovascular age-related macular degeneration in eyes previously treated with other vascular endothelial growth factor inhibitors. Am J Ophthalmol 156:23–28

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Cho H, Shah CP, Weber M, Heier JS (2013) Aflibercept for exudative AMD with persistent fluid on ranibizumab and/or bevacizumab. Br J Ophthalmol 97:1032–1035

    Article  PubMed  Google Scholar 

  10. Eadie JA, Gottlieb JL, Ip MS, Blodi BA, Danis RP, Chandra SR, Nork TM, Altaweel MM, Stern-Hogan BS (2014) Response to aflibercept in patients with persistent exudation despite prior treatment with bevacizumab or ranibizumab for age-related macular degeneration. Ophthalmic Surg Lasers Imaging Retina 45:394–397

    Article  PubMed  Google Scholar 

  11. Grewal DS, Gill MK, Sarezky D, Lyon AT, Mirza RG (2014) Visual and anatomical outcomes following intravitreal aflibercept in eyes with recalcitrant neovascular age-related macular degeneration: 12-month results. Eye (Lond) 28:895–899

    Article  CAS  Google Scholar 

  12. Yonekawa Y, Andreoli C, Miller JB, Loewenstein JI, Sobrin L, Eliott D, Vavvas DG, Miller JW, Kim IK (2013) Conversion to aflibercept for chronic refractory or recurrent neovascular age-related macular degeneration. Am J Ophthalmol 156:29–35

    Article  CAS  PubMed  Google Scholar 

  13. Miura M, Iwasaki T, Goto H (2013) Intravitreal aflibercept for polypoidal choroidal vasculopathy after developing ranibizumab tachyphylaxis. Clin Ophthalmol 7:1591–1595

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Gharbiya M, Iannetti L, Parisi F, De Vico U, Mungo ML, Marenco M (2014) Visual and anatomical outcomes of intravitreal aflibercept for treatment-resistant neovascular age-related macular degeneration. Biomed Res Int 2014:273754. doi:10.1155/2014/273754

    Article  PubMed  PubMed Central  Google Scholar 

  15. Fassnacht-Riederle H, Becker M, Graf N, Graf N, Michels S (2014) Effect of aflibercept in insufficient responders to prior anti-VEGF therapy in neovascular AMD. Graefes Arch Clin Exp Ophthalmol 252(11):1705–1709

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Wykoff CC, Brown DM, Maldonado ME, Croft DE (2014) Aflibercept treatment for patients with exudative age-related macular degeneration who were incomplete responders to multiple ranibizumab injections (TURF trial). Br J Ophthalmol 98:951–955

    Article  PubMed  PubMed Central  Google Scholar 

  17. Heussen FM, Shao Q, Ouyang Y, Joussen AM, Müller B (2014) Clinical outcomes after switching treatment from intravitreal ranibizumab to aflibercept in neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 252:909–915

    Article  CAS  PubMed  Google Scholar 

  18. Singh RP, Srivastava S, Ehlers JP, Bedi R, Schachat AP, Kaiser PK (2014) A single-arm, investigator-initiated study of the efficacy, safety and tolerability of intravitreal aflibercept injection in subjects with exudative age-related macular degeneration, previously treated with ranibizumab or bevacizumab: 6-month interim analysis. Br J Ophthalmol 98:i22–i27

    Article  PubMed  PubMed Central  Google Scholar 

  19. Saito M, Kano M, Itagaki K, Oguchi Y, Sekiryu T (2014) Switching to intravitreal aflibercept injection for polypoidal choroidal vasculopathy refractory to ranibizumab. Retina 34:2192–2201

    Article  CAS  PubMed  Google Scholar 

  20. Kumar N, Marsiglia M, Mrejen S, Fung AT, Slakter J, Sorenson J, Freund KB (2013) Visual and anatomical outcomes of intravitreal aflibercept in eyes with persistent subfoveal fluid despite previous treatments with ranibizumab in patients with neovascular age-related macular degeneration. Retina 33:1605–1612

    Article  CAS  PubMed  Google Scholar 

  21. Ferrone PJ, Anwar F, Naysan J, Chaudhary K, Fastenberg D, Graham K, Deramo V (2014) Early initial clinical experience with intravitreal aflibercept for wet age-related macular degeneration. Br J Ophthalmol 98:i17–i21

    Article  PubMed  PubMed Central  Google Scholar 

  22. Binder S (2012) Loss of reactivity in intravitreal anti-VEGF therapy: tachyphylaxis or tolerance? Br J Ophthalmol 96:1–2

    Article  PubMed  Google Scholar 

  23. Eghøj MS, Sørensen TL (2012) Tachyphylaxis during treatment of exudative age-related macular degeneration with ranibizumab. Br J Ophthalmol 96:21–23

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors have full control of all primary data and they have agreed to allow Graefe's Archive for Clinical and Experimental Ophthalmology to review their data upon request.

Financial disclosure

Drs. Cohen, Oubraham, and Souied are consultants for Bayer and Novartis, who market aflibercept and ranibizumab, respectively, in Europe. The authors declare no conflicting relationships.

This work was supported by an unrestricted grant from CIL-ASSOC (Paris, France), a research and education association. The funding organization had no role in the design or conduct of this research.

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Authors and Affiliations

  1. Department of Ophthalmology, Hôpital Intercommunal de Créteil, Faculté de médecine Henri Mondor, Université Paris Est Créteil, 40 avenue de Verdun, 94000, Créteil, France

    Raphaelle Despreaux, Salomon Y. Cohen, Oudy Semoun, Olivia Zambrowski, Hassiba Oubraham & Eric H. Souied

  2. Centre Ophtalmologique d’Imagerie et de Laser, Paris, France

    Salomon Y. Cohen

  3. Centre de Recherche Clinique- Centre de Ressources Biologiques, Hôpital Intercommunal de Créteil, Faculté de médecine Henri Mondor, Université Paris Est Créteil, Créteil, France

    Camille Jung & Eric H. Souied

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  1. Raphaelle Despreaux
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  2. Salomon Y. Cohen
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Correspondence to Salomon Y. Cohen.

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Despreaux, R., Cohen, S.Y., Semoun, O. et al. Short-term results of switchback from aflibercept to ranibizumab in neovascular age-related macular degeneration in clinical practice. Graefes Arch Clin Exp Ophthalmol 254, 639–644 (2016). https://doi.org/10.1007/s00417-015-3084-1

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  • DOI: https://doi.org/10.1007/s00417-015-3084-1

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