Switch to aflibercept or ranibizumab after initial treatment with bevacizumab in eyes with neovascular AMD

Publication

Switch to aflibercept or ranibizumab after initial treatment with bevacizumab in eyes with neovascular AMD

Journal Paper/Review - May 23, 2017

Waizel Maria, Todorova Margarita, Masyk Michael, Wolf Katharina, Rickmann Annekatrin, Helaiwa Khaled, Blanke Björn R., Szurman Peter

Citation

Waizel M, Todorova M, Masyk M, Wolf K, Rickmann A, Helaiwa K, Blanke B, Szurman P. Switch to aflibercept or ranibizumab after initial treatment with bevacizumab in eyes with neovascular AMD. BMC Ophthalmol 2017; 17:79.

Type

Journal Paper/Review (English)

Journal

BMC Ophthalmol 2017; 17

Publication Date

May 23, 2017

Brief description/objective

BACKGROUND: To evaluate changes in central macular thickness (CMT) and visual outcome in patients with neovascular age-related macular degeneration (AMD) treated initially with bevacizumab and subsequently switched to either aflibercept or ranibizumab.

METHODS: Observational clinical study was performed. We measured the structural outcome (CMT on SD-OCT; μm) and the visual outcome (best corrected visual acuity (BCVA); logMAR), as follows: before treatment (at baseline), following bevacizumab treatment (switch follow-up) and after switching from bevacizumab to aflibercept- or ranibizumab treatment (final follow-up, AG/, RG).

RESULTS: From a total of 96 eyes treated with intravitreal injections of bevacizumab (10.5 ± 7.6 (mean ± SD)), 58 eyes switched to aflibercept (6.5 ± 3.9; AG) and 38 eyes switched to ranibizumab (7.1 ± 5.3; RG) (≥ 3 injections, each). In addition, these eyes were compared to 37 eyes under bevacizumab monotherapy.

PRIMARY OUTCOME: In the AG, the CMT decreased slightly from 430 ± 220 μm at baseline to 419 ± 212 μm at switch follow-up (p = 0.86), but decreased significantly to 318 ± 159 μm at final follow-up, AG (p < 0.0001). In the ranibizumab group (RG), the CMT increased from 396 ± 174 μm at baseline to 499 ± 333 μm at switch follow-up (p = 0.012), but decreased significantly to 394 ± 202 μm at final follow-up, RG (p = 0.007). Secondary outcome: In the AG, the mean BCVA worsened from logMAR 0.57 ± 0.33 at baseline to 0.63 ± 0.30 at switch follow-up and improved slightly to 0.53 ± 0.71 at final follow-up, AG (p = 0.46). In the RG, mean BCVA worsened from 0.57 ± 0.28 at baseline to 0.64 ± 0.31 at switch follow-up and improved slightly to 0.60 ± 0.36 at final follow-up, RG (p = 0.64).

CONCLUSION: Switching from bevacizumab to either aflibercept, or ranibizumab, has a strong anatomical effect in eyes with neovascular AMD. Nevertheless, even if the switch to aflibercept shows a minimal functional benefit over that to ranibizumab, visual prognosis remains limited.