Aflibercept more effectively weans patients with neovascular age-related macular degeneration off therapy compared with bevacizumab

• Published in: The Journal of clinical investigation 2023-01, Vol.133 (2), p.1-12
• Main Authors: Cao, Xuan, Sanchez, Jaron Castillo, Patel, Tapan P, Yang, Zhiyong, Guo, Chuanyu, Malik, Danyal, Sopeyin, Anuoluwapo, Montaner, Silvia, Sodhi, Akrit
• Format: Article
• Language: English
• Subjects: Acuity; Age; Angiogenesis Inhibitors - therapeutic use; Bevacizumab; Bevacizumab - therapeutic use; Biomedical research; Care and treatment; Clinical trials; Comparative analysis; Diabetic retinopathy; Drug therapy; Eye; Follow-Up Studies; Humans; Macular degeneration; Macular Degeneration - drug therapy; Monoclonal antibodies; Ophthalmology; Patient outcomes; Patients; Physiological aspects; Ranibizumab - adverse effects; Recombinant Fusion Proteins - therapeutic use; Retrospective Studies; Success; Therapeutics; Tomography; Treatment Outcome; Vascular endothelial growth factor; Vision; Visual acuity; Weaning
• ISSN: 1558-8238; 0021-9738; 1558-8238
• DOI: 10.1172/JCI159125

BACKGROUNDStudies assessing the efficacy of therapies for neovascular age-related macular degeneration (nvAMD) have demonstrated that aflibercept may have a longer treatment interval than its less-expensive alternative, bevacizumab. However, whether this benefit justifies the additional cost of aflibercept remains under debate. We have recently reported that a treat-and-extend-pause/monitor approach can be used to successfully wean 31% of patients with nvAMD off anti-VEGF therapy. Here, we examined whether the choice of therapy influences the outcomes of this approach.METHODSIn this retrospective analysis, 122 eyes of 106 patients with nvAMD underwent 3 consecutive monthly injections with either aflibercept (n = 70) or bevacizumab (n = 52), followed by a treat-and-extend protocol, in which the decision to extend the interval between treatments was based on visual acuity, clinical exam, and the presence or absence of fluid on optical coherence tomography. Eyes that remained stable 12 weeks from their prior treatment were given a 6-week trial of holding further treatment, followed by quarterly monitoring. Treatment was resumed for worsening vision, clinical exam, or optical coherence tomography findings.RESULTSAt the end of 1 year, eyes receiving bevacizumab had similar vision but required more injections (8.7 ± 0.3 treatments vs. 7.2 ± 0.3 treatments) compared with eyes receiving aflibercept. However, eyes treated with aflibercept were almost 3 times more likely to be weaned off treatment (43% vs. 15%) compared with eyes treated with bevacizumab at the end of 1 year.CONCLUSIONThese observations expose an advantage of aflibercept over bevacizumab and have important clinical implications for the selection of therapy for patients with nvAMD.FUNDINGThis work was supported by the National Eye Institute, NIH grants R01EY029750 and R01EY025705, Research to Prevent Blindness, the Alcon Young Investigator Award from the Alcon Research Institute, and the Branna and Irving Sisenwein Professorship in Ophthalmology.