Original article
Conversion to Aflibercept For Chronic Refractory Or Recurrent Neovascular Age-Related Macular Degeneration

https://doi.org/10.1016/j.ajo.2013.03.030Get rights and content

Purpose

To explore the visual and anatomic outcomes of patients with refractory or recurrent neovascular age-related macular degeneration (AMD) who were converted from bevacizumab and/or ranibizumab to aflibercept.

Design

Two-center, retrospective chart review.

Methods

Treatment history, visual acuity (VA), and central macular thickness (CMT) on spectral-domain optical coherence tomography were collected. Patients were divided into “refractory” (persistent exudation despite monthly injections) or “recurrent” (exudation suppressed, but requiring frequent injections).

Results

One hundred and two eyes of 94 patients were included; 68 were refractory and 34 were recurrent. Eyes received a mean of 20.4 prior bevacizumab/ranibizumab injections and a mean of 3.8 aflibercept injections. Mean follow-up was 18 weeks. Mean VA was 20/50-1 before conversion, 20/50-2 after 1 aflibercept injection (P = .723), and 20/50+2 after the final injection (P = .253). Subgroup analysis of refractory and recurrent cases also showed stable VA. Of the refractory cases, mean CMT had improved after 1 injection (P < .001) and the final injection (P < .001). Intraretinal (P < .001) and subretinal (P < .001) fluid decreased after 1 injection, and the mean injection interval was extended from 5.2 to 6.2 weeks (P = .003). Of the recurrent cases, mean CMT improved after 1 injection (P < .001) and the final injection (P < .001). Intraretinal (P = .003) and subretinal (P = .046) fluid decreased after 1 injection, and the mean injection interval was extended from 7.2 to 9.5 weeks (P = .001).

Conclusions

Converting patients with chronic neovascular AMD to aflibercept results in stabilized vision and improved anatomic outcomes, while allowing injection intervals to be extended.

Section snippets

Methods

This study is a retrospective, interventional, noncomparative case series of consecutive patients treated at the Massachusetts Eye and Ear Infirmary and Harvard Vanguard Medical Associates. Subjects were identified in our electronic medical records as those with neovascular AMD who were previously treated with ranibizumab and/or bevacizumab and then converted to aflibercept between December 1, 2011, and July 31, 2012. Exclusion criteria were concomitant visually significant ocular pathology

Patient Characteristics

One hundred patients (108 eyes) with neovascular AMD who were converted from bevacizumab or ranibizumab to aflibercept were identified. Six patients (6 eyes) were excluded because of vitreous hemorrhage (1), corneal pathology (1), lack of follow-up (1), and use of ranibizumab only once before aflibercept conversion in newly diagnosed patients (3). The remaining cohort was composed of 94 patients (102 eyes). Patient characteristics at the time of aflibercept conversion are summarized in Table 1.

Treatment Characteristics

Discussion

Aflibercept is the most recent addition to the armamentarium of intravitreal anti-VEGF agents. The high binding affinity of the decoy receptor allows for bimonthly dosing after 3 initial monthly doses, as demonstrated by the VIEW trials.10 The properties of aflibercept that result in longer duration of action could also theoretically lead to improved efficacy in patients with suboptimal responses to ranibizumab or bevacizumab.

In the current study, we examined the visual and anatomic response of

Yoshihiro Yonekawa, MD, graduated from Weill Cornell Medical College and is currently a resident at the Massachusetts Eye and Ear Infirmary.

References (19)

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Yoshihiro Yonekawa, MD, graduated from Weill Cornell Medical College and is currently a resident at the Massachusetts Eye and Ear Infirmary.

Ivana K. Kim, MD, is Associate Professor of Ophthalmology at Harvard Medical School and a member of the Retina Service at Massachusetts Eye and Ear Infirmary. She graduated from Harvard Medical School and completed her ophthalmology residency and vitreoretinal fellowship at the Massachusetts Eye and Ear Infirmary. Her clinical practice includes surgical and medical retina, with a focus on age-related macular degeneration and uveal melanoma. She is actively involved in clinical trials for retinal disease as well as studies of age-related macular degeneration genetics and molecular genetics of uveal melanoma.

See accompanying editorial on page 1.

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