Short-Term Outcomes of Aflibercept for Neovascular Age-Related Macular Degeneration in Eyes Previously Treated With Other Vascular Endothelial Growth Factor Inhibitors

• Published in: American journal of ophthalmology 2013-07, Vol.156 (1), p.23-28.e2
• Main Authors: Ho, Vincent Y, Yeh, Steven, Olsen, Timothy W, Bergstrom, Chris S, Yan, Jiong, Cribbs, Blaine E, Hubbard, G. Baker
• Format: Article
• Language: English
• Subjects: Age; Aged; Aged, 80 and over; Angiogenesis Inhibitors - adverse effects; Angiogenesis Inhibitors - therapeutic use; Antibodies, Monoclonal, Humanized - therapeutic use; Bevacizumab; Drug Substitution; Drug Therapy, Combination; Expert witness testimony; Eyes & eyesight; Female; Follow-Up Studies; Fovea Centralis - pathology; Health Insurance Portability & Accountability Act 1996-US; Heart attacks; Hemorrhage; Humans; Intravitreal Injections; Macular degeneration; Male; Middle Aged; Ophthalmology; Patients; Ranibizumab; Receptors, Vascular Endothelial Growth Factor - adverse effects; Receptors, Vascular Endothelial Growth Factor - therapeutic use; Recombinant Fusion Proteins - adverse effects; Recombinant Fusion Proteins - therapeutic use; Retrospective Studies; Tomography; Tomography, Optical Coherence; Treatment Outcome; Vascular endothelial growth factor; Vascular Endothelial Growth Factor A - antagonists & inhibitors; Visual Acuity - physiology; Wet Macular Degeneration - diagnosis; Wet Macular Degeneration - drug therapy; Wet Macular Degeneration - physiopathology
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2013.02.009

Purpose To report results of aflibercept therapy in eyes with neovascular age-related macular degeneration previously treated with bevacizumab, ranibizumab, or both. Design Retrospective, interventional, noncomparative, consecutive case series. Methods Ninety-six eyes from 85 patients with neovascular age-related macular degeneration who previously had received bevacizumab, ranibizumab, or both were treated with aflibercept monthly for 3 months followed by a fourth injection within 2 months. Outcomes were determined 4 ± 1 months after the first aflibercept dose and included: proportion of patients gaining or losing 2 lines or more of best-corrected visual acuity, proportion remaining within a gain or loss of 1 line, mean change in logarithm of the minimal angle of resolution visual acuity, mean change in central foveal thickness, mean change in macular cube volume, and qualitative anatomic response as assessed by spectral-domain optical coherence tomography. Results At baseline, 82 (85%) eyes had signs of active exudation despite a mean of 17 previous anti–vascular endothelial growth factor injections. At final visit, 82 (85%) remained stable within a gain or loss of 1 line, 7 (7%) gained 2 lines or more, and 7 (7%) lost 2 lines or more of best-corrected visual acuity. Mean logarithm of the minimal angle of resolution visual acuity showed minimal change 0.02 (range, −0.46 to 0.70; P  = .14). Mean central foveal thickness decreased −18 μm (range, −242 to 198 μm; P  = .06). Mean macular volume decreased −0.27 mm3 (95% confidence interval, −0.4 to −0.1 mm3 ; P  = .004). On qualitative analysis, 4 (5%) eyes had complete resolution of exudative fluid, 40 (49%) showed partial resolution, 26 (32%) remained unchanged, and 12 (14%) showed worsened exudative fluid. Conclusions Aflibercept seems to be an effective alternative for neovascular age-related macular degeneration patients previously treated with bevacizumab, ranibizumab, or both at 4 months of follow-up. Most treated eyes demonstrated stable visual acuity and anatomic improvements by spectral-domain optical coherence tomography.