Abstract
Purpose
To determine the proportion of treatment-experienced eyes with exudative age-related macular degeneration successfully treated with every-4-week aflibercept that can be kept dry on fixed every-8-week aflibercept injections (maintenance).
Methods
In this retrospective chart review, we evaluated our cohort of patients treated with a treatment paradigm for CNV in AMD. Initially, patients were treated with bevacizumab or ranibizumab and switched to every-4-week aflibercept when therapeutic responses were not durable or were suboptimal. Maintenance every-8-week therapy was initiated when the retina was completely dry on every-4-week aflibercept therapy. The primary outcome measure was recurrence of exudation on optical coherence tomography (OCT) during maintenance.
Results
Thirty-six eyes of 31 consecutive patients with median age of 79 years (range, 65–89) were included. Maintenance was started after a median of 34 (range, 8–88) injections. Recurrence was observed in 20 eyes (55%). Of these, 11 eyes (31%) reactivated at 8 weeks. Median time to failure of maintenance schedule was 40 weeks by Kaplan-Meier analysis. Baseline demographic and anatomic characteristics were not associated with failure of maintenance schedule.
Conclusion
In treatment-experienced eyes that respond completely to every-4-week aflibercept, maintenance therapy with every-8-week injections can only temporarily maintain anatomic success with the majority of eyes developing recurring activity. This regimen fails early in one third of eyes and has a median effective duration of 40 weeks. Aflibercept appears to be inadequate to maintain control of exudation in most eyes in at least half of eyes undergoing long-term therapy.
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Funding
This study was supported by the UCSD Vision Research Center Core Grant P30EY022589, an unrestricted fund from Research to Prevent Blindness, NY (WRF). The funding organization had no role in the design or conduct of this research.
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The authors declare that they have no conflict of interest.
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UCSD Institutional Review Board (IRB) approval was acquired for the review of patient data. All procedures adhered to the tenets of the 1964 Declaration of Helsinki for research involving human subjects and its later amendments. All procedures complied with the Health Insurance Portability and Accountability Act (HIPAA) regulations. This article does not contain any studies with animals performed by any of the authors.
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Each patient gave written informed consent prior to the intravitreal injections.
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The study was conducted and completed in the Jacobs Retina Center at the Shiley Eye Institute, University of California San Diego, La Jolla, California.
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Dans, K.C., Freeman, S.R., Lin, T. et al. Durability of every-8-week aflibercept maintenance therapy in treatment-experienced neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 257, 741–748 (2019). https://doi.org/10.1007/s00417-018-04232-8
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DOI: https://doi.org/10.1007/s00417-018-04232-8