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Posters

The impact of switching anti-vascular endothelial growth factor (anti-VEGF) therapy in the management of exudative age-related macular degeneration (AMD)

Poster Details

First Author: K.Chia SINGAPORE

Co Author(s):    A. Laude                  0   0 0   0 0   0 0   0 0

Abstract Details



Purpose:

To describe and compare the studies done on patients who had switched anti-VEGF therapy for exudative AMD. Anti-VEGF therapy is often switched due to cost, inadequate or non-response. We aim to explore if switching therapy produces similar efficacy; or in the case of inadequate or non-response, whether a switch in therapy improves clinical response.

Setting:

Retrospective review of published case series.

Methods:

We conducted a review of clinical research studies in exudative AMD published between 2009 and 2014 that reported their results after switching anti-VEGF therapy. Data on baseline disease characteristics, visual and anatomical outcomes were extracted and analysed.

Results:

We identified 17 case series in our review. Reasons for switch included tachyphylaxis, health insurance coverage, cost issues, non-response or inadequate response. Of these, only 9 studies had data that could be used for comparison between studies and these were all retrospective case studies. The median age was 79.0 years (range: 70-80) and the mean number of treated eyes in these studies was 40.2 (range:7-102). The median length of follow up 10.6 months (range 4.2 to 21.8). The mean baseline visual acuity (VA) ranged from logMar 0.42 to 0.94 (SD 0.05 - 0.50) and mean VA on final follow-up ranged from 0.38 to 0.78 (SD range0.08 - 0.50). 5 of 9 studies reported no statistically significant change in vision from baseline to last follow-up. The mean baseline central retinal thickness (CRT) ranged from 261μm to 416μm (SD range: 11μm - 217μm). The mean final CRT ranged from 237μm to 348μm (SD 10 μm - 171 μm). 5 of 9 studies reported a statistically significant change in CRT. The median change in CRT was -29 μm.

Conclusions:

Switching anti-VEGF in these studies did not appear to have had a significant functional effect in VA although it appeared to give some anatomical improvement. All the studies we analysed are retrospective and performed in a non-standardized manner, with different indications for switching, follow-up periods and re-treatment criteria. Future prospective studies with pre-determined entry criteria and follow up are recommended to fully explore the impact of switching anti-VEGF therapy.

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