Year 2019, Volume 5 , Issue 6, Pages 977 - 980 2019-11-04

Neovascular age-related macular degeneration: 18-month outcomes of aflibercept treatment in patients resistant to ranibizumab

Elif Ertan [1] , Mustafa Doğan [2]


Objectives: Aim of this study is to investigate the effect of intravitreal aflibercept therapy in an 18-month period in patients with recurrent neovascular age-related macular degeneration resistant to intravitreal ranibizumab.

Methods: This is a prospective study of eyes with neovascular age-related macular degeneration switched to intravitreal aflibercept with at least 18 month of follow-up after the switch. All patients had had a minimum of 6 injections of ranibizumab before the switch. All patients received a loading dose of three intravitreal 2 mg aflibercept injections at 4-week intervals. Changes in best-corrected visual acuity, central macular thickness and the frequency of injections were compared.

Results: The study included 39 patients, each with one diseased eye. The studied eyes had received an average of 10.74 ± 4.38 previous intravitreal ranibizumab injections over a period of 28.31 ± 18.08 months. During the study, an average of 6.94 ± 2.58 intravitreal aflibercept injections were given in a period of 18 months. Mean central macular thickness at baseline, before switching to aflibercept, 6, 12, and 18 months after the aflibercept injection were 327.44 ± 120.57, 354.50 ± 127.79, 290.20 ± 112.25, 311.70 ± 119.47, and 299.29 ± 98.38 μm, respectively. A significant change was found in the macular thickness measured at intervals throughout the study. However, no significant improvement was found in visual acuity after 18 month after switching to aflibercept.

Conclusions: Switching from intravitreal ranibizumab, an inhibitor of vascular endothelial growth factor-A, to aflibercept, another inhibitor for such factors, has increased central macular thickness significantly without changes in visual acuity. 

age-related macular degeneration, aflibercept, ranibizumab, switch
  • [1] Congdon N, O'Colmain B, Klaver CC, Klein R, Muñoz B, Friedman DS, et al; Eye Diseases Prevalence Research Group. Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol 2004;122:477-85.
  • [2] Holash J, Davis S, Papadopoulos N, Croll SD, Ho L, Russell M, et al. VEGF-Trap: a VEGF blocker with potent antitumor effects. Proc Natl Acad Sci U S A 2002;99:11393-8.
  • [3] Papadopoulos N, Martin J, Ruan Q, Rafique A, Rosconi MP, Shi E, et al. Binding and neutralization of vascular endothelial growth factor (VEGF) and related ligands by VEGF Trap, ranibizumab and bevacizumab. Angiogenesis 2012;15:171-85.
  • [4] Binder S. Loss of reactivity in intravitreal anti-VEGF therapy: tachyphylaxis or tolerance? Br J Ophthalmol 2012;96:1-2.
  • [5] Chang AA, Li H, Broadhead GK, Hong T, Schlub TE, Wijeyakumar W, et al. Intravitreal aflibercept for treatment-resistant neovascular age-related macular degeneration. Ophthalmology 2014;121:188-92.
  • [6] Kumar N, Marsiglia M, Mrejen S, Fung AT, Slakter J, Sorenson J,et al. Visual and anatomicaloutcomes of intravitreal aflibercept in eyes with persistent subfoveal fluid despite previous treatments with ranibizumab in patients with neovascular age-related macular degeneration. Retina 2013;33:1605-12.
  • [7] Ricci F, Parravano M, Regine F, Sciamanna M, Tedeschi M, Missiroli F, et al. Aflibercept in persistent neovascular AMD: comparison of different treatment strategies in switching therapy. Eye (Lond) 2017;31:163-4.
  • [8] Cho H, Shah CP, Weber M, Heier JS. Aflibercept for exudative AMD with persistent fluid on ranibizumab and/or bevacizumab. Br J Ophthalmol 2013;97:1032-5.
  • [9] Grewal DS, Gill MK, Sarezky D, Lyon AT, Mirza RG. Visual and anatomical outcomes following intravitreal aflibercept in eyes with recalcitrant neovascular age-related macular degeneration: 12-month results. Eye (Lond) 2014;28:895-9.
  • [10] Bakall B, Folk JC, Boldt HC, Sohn EH, Stone EM, Russell SR, et al. Aflibercept therapy for exudative age-related macular degeneration resistant to bevacizumab and ranibizumab. Am J Ophthalmol 2013;156:15-22.
  • [11] Grunwald JE, Pistilli M, Ying G, Maguire MG, Daniel E, Martin DF. Growth of geographic atrophy in the comparison of age-related macular degeneration treatments trials. Ophthalmology 2015;122:809-16.
  • [12] Browning DJ, Kaiser PK, Rosenfeld PJ, Stewart MW. Aflibercept for age-related macular degeneration: a game-changer or quiet addition? Am J Ophthalmol 2012;154:222-6.
Primary Language en
Subjects Ophthalmology
Journal Section Original Articles
Authors

Orcid: 0000-0001-5147-9814
Author: Elif Ertan (Primary Author)
Institution: Department of Ophthalmology, Kurtalan State Hospital, Siirt, Turkey
Country: Turkey


Orcid: 0000-0001-7237-9847
Author: Mustafa Doğan
Institution: Department of Ophthalmology, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey
Country: Turkey


Dates

Publication Date : November 4, 2019

EndNote %0 The European Research Journal Neovascular age-related macular degeneration: 18-month outcomes of aflibercept treatment in patients resistant to ranibizumab %A Elif Ertan , Mustafa Doğan %T Neovascular age-related macular degeneration: 18-month outcomes of aflibercept treatment in patients resistant to ranibizumab %D 2019 %J The European Research Journal %P -2149-3189 %V 5 %N 6 %R doi: 10.18621/eurj.446300 %U 10.18621/eurj.446300