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Long‐term outcomes of switching to aflibercept for treatment‐resistant neovascular age‐related macular degeneration
Author(s) -
Spooner Kimberly,
Hong Thomas,
Nair Rashmi,
Chow Nicholas Chian Chiang,
Broadhead Geoffrey K.,
Wijeyakumar Wijeyanthy,
Chang Andrew A.
Publication year - 2019
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/aos.14046
Subject(s) - aflibercept , medicine , macular degeneration , ranibizumab , ophthalmology , visual acuity , pro re nata , prospective cohort study , bevacizumab , surgery , chemotherapy
Purpose To report 4‐year outcomes following the switch to aflibercept in treatment‐resistant neovascular age‐related macular degeneration ( nAMD ). Methods In this prospective, open‐label, non‐controlled, clinical trial, 49 patients with treatment‐resistant nAMD received 2 mg intravitreal aflibercept as three loading doses every 4 weeks, followed by injections every 8 weeks for the first 48 weeks, then an individualized regimen for a further 36 months, following previous treatment with ranibizumab and/or bevacizumab. Outcome measures included best‐corrected visual acuity ( BCVA ), central retinal thickness ( CRT ), pigment epithelial detachment ( PED ) height and geographic atrophy ( GA ) surface area. Results Of the 49 patients who were initially recruited, data from 39 eyes of 39 patients were available at 48‐month follow‐up. Mean age was 76.7 ± 7.2 years. Over the 48 months, these eyes received a mean of 32.1 ± 5.6 injections. The mean BCVA improved significantly following 12 months of treatment (4.9 ± 9.0 ETDRS letters, p < 0.001); however, this was not maintained and was similar to baseline after 48 months (mean difference −0.4 ± 13.3 letters between baseline and 48 months, p < 0.001). The reduction in CRT from baseline was 170.3 ± 143.3 μ m (p < 0.001) with absence of macular fluid in 56% of the 39 eyes at the end of month 48. PED height reduced by a mean 77.5 ± 20.0 μ m, and geographic atrophy increased by a mean of 4.1 ± 3.4 mm 2 (p < 0.01) over the 48 months. Conclusion Aflibercept is an effective alternative therapy for treatment‐resistant nAMD . Good anatomical and stable functional responses are achievable with continued therapy. The lack of continued visual improvement may be representative of GA progression, reflecting the progression of late‐stage nAMD in these patients.