First Author: H.Almuhtaseb UK
Co Author(s): L. Michaels T. Vardarinos A. Lotery
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To directly compare visual acuity (VA) outcomes in year 1 of treatment with aflibercept vs. ranibizumab for eyes with neovascular macular degeneration (nAMD) treated in two centres by two different treatment regimens.
Retrospective data analysis. 100 Treatment-naïve eyes received aflibercept or ranibizumab. In Group A (University Hospital Southampton: 51 eyes) aflibercept was used per VIEW protocol. In Centre B (West Suffolk Hospital: 49 eyes) ranibizumab was used per treat and extend (T&E) protocol.
Group A received aflibercept per VIEW protocol (Q8W) with a total of 3 Clinic Visits (3 OCTs) during a year of treatment. Group B received Lucentis per T&E protocol: After a loading of 3 IVIs, inter-IVI interval was extended/shortened by 2 weeks based on disease activity. Mean change in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) at year 1 compared to baseline, mean number of injections and visits were collected. Economic analysis was performed based on data from the coding department.
Baseline parameters were well matched (age, baseline BCVA). The mean VA of Group A eyes improved from 0.49 logMAR at baseline to 0.34 logMAR (+7.5 ETDRS L gain [P = 0.0010]) at end of year 1 (Y1), compared with 0.48 logMAR at baseline to 0.32 logMAR (+8.3 ETDRS L gain [P < 0.0001]) for Group B. Mean BCVA Group A vs mean BCVA Group B (P=0.1550). The mean CRT of Group A improved from 296 μm at baseline to 214 at Y1. The mean CRT of Group B improved from 428 μm at baseline to 272 at Y1. In Group A vs. Group B comparisons, the mean numbers of IVIs were 7 vs. 7.75 (P < 0.0001) and clinic visits were 3 vs. 5.75 (P=0.0001). In the T&E group, IVI and Clinic Visit numbers ranged from 5-11. Economic analysis revealed the total mean cost per patient per annum was £6919.00 for aflibercept per Southampton protocol, £7395.00 for ranibizumab per the T&E protocol.
Visual gains were significant and comparable for both aflibercept (Q8W) and ranibizumab (T&E) used proactively in year 1. Differences between the 2 regimens were significant when mean numbers of IVIs and clinic visits were compared. From an economic point of view, Southampton protocol for aflibercept is more cost effective compared to T&E for ranibizumab in Y1 of treatment. Larger case series and/or RCTs are needed to give further evidence.