Posters

Two-year outcomes of aflibercept for neovascular age-related macular degeneration: Multiple treatment regimens in year two based on the macular status at the end of year one

Poster Details

First Author: H.Almuhtaseb UK

Co Author(s):    L. Michaels   A. Youssef   S. Kanavati   C. Rennie   A. Lotery                 

Abstract Details



Purpose:

To directly compare visual acuity (VA) outcomes in year 2 of treatment with aflibercept for eyes with neovascular age-related macular degeneration (nAMD) treated in a single centre by three different treatment regimens in year 2 [Fixed-dosing Q8W, Capped PRN (CPRN) and Treat and Extend (T&E)], and to evaluate the efficacy of shortening the Aflibercept inter-injection interval to < Q8W in year 2.

Setting:

Single centre retrospective data analysis from an electronic medical record (EMR) system of a sample of 105 treatment-naïve eyes treated with Aflibercept at the Eye unit at University Hospital Southampton NHS Foundation Trust and completed 2 years of treatment.

Methods:

In year 1 (Y1), eyes were treated per VIEW 1&2 Clinical Trials’ modified protocol. In year 2 (Y2), eyes were treated implementing 3 different treatment regimens based on the macular status at the end of Y1: [Macular Status end Y1, Treatment Regimen, (n: number of eyes)]: Wet macula, Q8W, 30; Dry macula,CPRN,25; and Dry macula,T&E,23. A 4th sub-group (27 eyes with wet maculae at end of Y1), was treated more frequently (Q6W/Q4W) instead of Q8W in year 1. Main outcome measures were mean change in BCVA and CRT at Y2 compared to Y1 and to baseline, mean number of injections and follow-up visits in year 2.

Results:

Mean LogMAR BCVA of the three groups was comparable at baseline: 0.64, 0.65 and 0.64 for the Q8W {Group 1}, CPRN {Grop 2} and T&E {Group 3} groups (groups 1-3 in this order) respectively. Mean LogMAR BCVA and [CRT in microns] at M11 (end of Y1) of the three groups improved to 0.45 [235], 0.54 [177] and 0.50 [196] for groups 1-3 respectively (P statistically significant for mean BCVA and CRT at M11 compared to baseline for the three groups). Mean LogMAR BCVA and [CRT in microns] at M23 (end of Y2) were 0.40[220], 0.54[199] and 0.50[188] for groups 1-3 respectively. Average number of IVIs given during Y2 was 6,4 (range 4-5) and 5 (range 4-9) in groups 1-3 respectively (ANOVA: statistical significance in all inter-group comparisons). Average number of Clinic Visits in Y2 was 2, 6 and 5 (range 4-9) in groups 1-3 respectively (ANOVA test: statistical significance in all inter-group comparisons). Mean [SD] LogMAR BCVA of Group 4 pre- and post-switch into Aflibercept Q6W/Q4W were 0.40 [0.17] and 0.44 [0.21] respectively.

Conclusions:

Visual gain at the end of year one was maintained through the 2-year treatment plan in groups 1-3. At month 11, active maculae did not have worse VA outcomes cf. inactive lesions. Fixed-dosing Q8W, CPRN and T&E are proactive regimens that would guarantee maintenance of the gain achieved in Y1. Shortening the Aflibercept inter-injection interval down to 6 or 4 weeks might not guarantee better VA and anatomic benefit. Aflibercept Q8W for wet maculae at M11 is a cost-effective treatment regimen as it maintains the gains of Y1 gain with the lowest number of follow-up visits (2 F/up visits only in year 2).

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