Original articleConversion to Aflibercept For Chronic Refractory Or Recurrent Neovascular Age-Related Macular Degeneration
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.
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2019, CellCitation Excerpt :The report that administration of bevacizumab, despite disease progression in metastatic colorectal cancer, still resulted in a small but significant OS benefit raised the possibility that resistance may be reversible, at least in some circumstances, and suggested that re-treating with the same or an alternate VEGF inhibitor may have clinical benefit (Bennouna et al., 2013). In retinal diseases, some clinical studies have reported an interesting positive therapeutic response upon switching from one anti-VEGF agent to another after a clinical determination of treatment resistance with the initial agent used for therapy (Bakall et al., 2013; Gasperini et al., 2012; Spooner et al., 2018; Yonekawa et al., 2013). Although intriguing, this finding has not been universally observed across all clinical studies (Stepien et al., 2009).
The outcomes of aflibercept therapy in patients with age-related macular degeneration resistant to bevacizumab or ranibizumab
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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.