Open AccessEfficacy and Safety of Intravitreal Aflibercept Treat and Extend for Polypoidal Choroidal Vasculopathy in the ATLANTIC Study: A Randomized Clinical Trial
Author(s) -
Rufino Silva,
Luís Arias,
Sandriunes,
Cláudia Farinha,
Rita Coimbra,
João Pedro Marques,
Maria Luz Cachulo,
João Figueira,
Patrícia Barreto,
Maria Madeira,
Isabel Pires,
João C. Sousa,
Laura Distéfano,
Paulo Caldeira Rosa,
Ângela Carneiro,
Sara Vaz-Pereira,
Angelina Meireles,
Francisco Cabrera,
Anniken Burés,
Luís Mendonça,
Alvaro Fernandez-Vega-Sanz,
Sandra Barrão,
Adrian Koh,
Chui Ming Gemmy Cheung,
José CunhaVaz,
Joaquim Murta
Publication year - 2021
Publication title -
ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.639
H-Index - 60
eISSN - 1423-0267
pISSN - 0030-3755
DOI - 10.1159/000518235
Subject(s) - aflibercept , medicine , verteporfin , ophthalmology , interquartile range , visual acuity , randomized controlled trial , choroidal neovascularization , population , surgery , bevacizumab , chemotherapy , environmental health
Importance: Polypoidal choroidal vasculopathy (PCV) is far less common and studied in a Caucasian population than in an Asian population, and the optimal treatment approach remains to be confirmed. Methods: A 52-week, double-masked, sham-controlled, phase 4, investigator-initiated randomized clinical trial (RCT) in naive symptomatic Caucasian patients with PCV treated with aflibercept in a treat-and-extend regimen (T&E) (intravitreal aflibercept injection [IVAI] T&E). Patients were randomized at week 16 to receive IVAI T&E plus either sham photodynamic therapy (PDT) or standard fluence PDT with verteporfin. The main outcome measures were changes in best-corrected visual acuity (BCVA) from baseline to 52 weeks and polyp occlusion at week 52. Data are presented as median (interquartile range [IQR]) for BCVA, number of IVAI, and change in central retinal thickness (CRT). Results: Of the 50 patients included in the study, 48 patients completed the 52 weeks of follow-up. During this period, a significant median (IQR) BCVA gain of 6 [2–12] Early Treatment Diabetic Retinopathy Study letters was observed for all patients ( p < 0.001), after 8 (7–9) injections, with a significant reduction of −93.0 [−154.0, −44.0] µm in central macular thickness ( p < 0.001). Using indocyanine green angiography, a complete occlusion of polypoidal lesions was documented in 72% of the cases. Still, no significant difference was detected between the sham PDT and the aflibercept PDT arms, at week 52, for BCVA change (6.5 [2–11] vs. 5 [2–13] letters ( p = 0.98)), number of IVAIs (8.5 [7–9] vs. 8 [7–9] ( p = 0.21)), change in CRT (−143 [−184; −47] vs. −89 [−123; −41.5] µm [ p = 0.23]), and rates of complete polyp occlusion: 77 versus 68% ( p = 0.53) or presence of fluid: 68 versus 57% ( p = 0.56). No serious ocular adverse events were registered in the 2 arms. Conclusions and Relevance: To our knowledge, this is the first RCT to compare aflibercept T&E monotherapy with aflibercept T&E plus verteporfin PDT in a Caucasian population with PCV. Aflibercept monotherapy in a T&E showed to be effective and safe with a significant median BCVA improvement of 6 letters and a complete occlusion of polypoidal lesions in near 3 quarters of the eyes, at 1 year. As only 22% of the eyes underwent PDT treatment, the benefit of combined treatment for PCV in Caucasian patients could not be definitively elucidated from this study. Trial Registration: The clinical trial was registered in ClinicalTrials.gov Identifier NCT02495181 and the European Union Drug Regulating Authorities Clinical Trials Database EudraCT No. 2015-001368-20.