First Author: K.Chia SINGAPORE
Co Author(s): A. Laude 0 0 0 0 0 0 0 0 0
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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.
Retrospective review of published case series.
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.
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.
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.