Comparison of time to retreatment and visual function between ranibizumab and aflibercept in age-related macular degeneration

• Published in: American journal of ophthalmology 2016-09, Vol.169, p.95-103
• Main Authors: Inoue, Maiko, Yamane, Shin, Sato, Shimpei, Sakamaki, Kentaro, Arakawa, Akira, Kadonosono, Kazuaki
• Format: Article
• Language: English
• Subjects: Age; Aged; Aged, 80 and over; Angiogenesis Inhibitors - therapeutic use; Clinical deterioration; Confidence intervals; Female; Fluorescein Angiography; Funding; Humans; Immunotherapy; Intravitreal Injections; Macular degeneration; Male; Medical imaging; Middle Aged; Monoclonal antibodies; Multivariate analysis; Ophthalmology; Patients; Ranibizumab - therapeutic use; Receptors, Vascular Endothelial Growth Factor - therapeutic use; Recombinant Fusion Proteins - therapeutic use; Retreatment; Retrospective Studies; Studies; Subretinal Fluid; Time-to-Treatment; Tomography, Optical Coherence; Vascular endothelial growth factor; Vascular Endothelial Growth Factor A - antagonists & inhibitors; Visual Acuity - drug effects; Visual Acuity - physiology; Wet Macular Degeneration - drug therapy; Wet Macular Degeneration - physiopathology
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2016.06.021

Abstract Purpose To compare time to retreatment and visual function between patients with treatment-naïve neovascular age-related macular degeneration (AMD) treated with either intravitreal ranibizumab (IVR) or intravitreal aflibercept (IVA) in routine clinical practice. Design Retrospective, interventional comparative case series. Participants A total of 200 eyes of 197 patients with neovascular AMD. Methods A total of 99 patients in the IVR group and 101 patients in the IVA group who met the inclusion criteria with 12 months of follow up were included in the present study. All patients received three consecutive monthly injections of 0.5 mg/0.05 mL ranibizumab or 2.0 mg/0.05 mL aflibercept as loading doses. Retreatment was allowed if evidence of clinical deterioration or the presence of intraretinal edema or subretinal fluid on spectral-domain optical coherence tomography examination performed at the 1-month follow-up was noted. The time to retreatment after the third injection during the loading phase to the first recurrence during the maintenance phase was compared between treatments using the Kaplan–Meier analysis. Functional and anatomical outcomes were also compared between the IVR and IVA groups. Results The median time to retreatment after the last induction dose was 5 months in both groups. The proportion of IVR patients who required injection retreatment was not significantly higher than that of IVA patients (67.7% and 63.4%, respectively, at the 12-month follow up; log rank test, P = .554). In both groups, significant improvements in postoperative best-corrected visual acuity (BCVA) compared with preoperative visual acuity was observed over the 12-month follow-up period ( P < .05 for both). Central foveal thickness (CFT) decreased from the baseline values in both groups during the follow-up period ( P < .001 for both). Although there was a trend toward greater BCVA improvements in the IVA group, no significant differences in BCVA or CFT were observed between the treatment groups. Conclusions Both IVR and IVA were well tolerated and demonstrated efficacy in improving the visual acuity in treatment-naïve patients with AMD. Despite a trend toward greater BCVA improvements in the IVA group, a similar injection burden was observed following the loading phases of both ranibizumab and aflibercept.