Short-term results of switchback from aflibercept to ranibizumab in neovascular age-related macular degeneration in clinical practice
- 1.6k Downloads
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.
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.
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.
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.
KeywordsAge-related macular degeneration Choroidal neovascularization Switch Switchback Anti-VEGF Ranibizumab Aflibercept
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.
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.
- 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 97:1161–1167CrossRefPubMedPubMedCentralGoogle 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 98:1205–1207CrossRefPubMedGoogle 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 156:23–28CrossRefPubMedPubMedCentralGoogle 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 45:394–397CrossRefPubMedGoogle 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–i27CrossRefPubMedPubMedCentralGoogle 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 33:1605–1612CrossRefPubMedGoogle Scholar