First Author: P.Cardoso PORTUGAL
Co Author(s): A. Pinheiro J. Meira A. Pedrosa J. Pinheiro-Costa M. S. Falcao A. Carneiro
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To evaluate the clinical outcomes of intravitreal aflibercept therapy in eyes with refractory and recurrent neovascular age-related macular degeneration (AMD) switched from intravitreal bevacizumab or ranibizumab.
Centro Hospitalar de São João, Porto, Portugal
We retrospectively studied eyes with neovascular AMD switched to intravitreal aflibercept with at least 1 year of follow-up after the switch and up to 3 years. All patients had had a minimum of 3 injections of bevacizumab or ranibizumab before the switch. Aflibercept was used in patients considered refractory to bevacizumab (group 1) and in recurrent patients on therapy with ranibizumab due to an institutional policy decision (group 2). Changes in best-corrected visual acuity, fluid on optical coherence tomography (OCT), central retinal thickness (CRT) and the frequency of injections were compared.
One hundred and sixty-four eyes of 134 patients were analyzed, 101 eyes in group 1 and 63 in group 2. The mean follow-up time was 28.5 months prior to the switch and 29.9 months on treatment with aflibercept. One year after the switch, there was a nonsignificant mean decrease of 2 letters in visual acuity in both groups (group 1: from 56.5 to 54.8 letters, p = 0.108; group 2: from 56.3 to 54.3 letters, p = 0.127). However, three years after the switch, there was a significant mean decrease of 9 letters in visual acuity in group 1 (from 59.9 to 50.8 letters, p = 0.016) and a significant decrease of 6 letters in group 2 (from 56.3 to 50.1 letters, p = 0.001). With the switch there was a significant improvement in the CRT mean at 1, 2 and 3 years follow-up (73 µm, 125 µm, 88 µm, respectively: p < 0.001). Comparing the first year under treatment with aflibercept versus the third, there’s a significant decrease in the mean number of injections per month (0.66 to 0.53, p < 0.001).
Aflibercept appears to be a valuable tool for the management of patients with poor responses to other anti-vascular endothelial growth factor drugs. These patients could have a stabilization of visual loss in the first year, however, in the long term there is a significant decrease of visual acuity despite good morphological results and good control of the signs of disease activity on the OCT.