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Fixed bimonthly aflibercept in naïve and switched neovascular age related macular degeneration patients: 1 year outcomes

Fixed bimonthly aflibercept in naïve and switched neovascular age related macular degeneration patients: 1 year outcomes
Fixed bimonthly aflibercept in naïve and switched neovascular age related macular degeneration patients: 1 year outcomes
Aim: To determine real life clinical outcomes in poorly responsive and treatment-naïve neovascular age related macular degeneration (nvAMD) patients using bi-monthly fixed dosing aflibercept regimen.

Methods: This was a retrospective study of 165 eyes with nvAMD started on aflibercept at Southampton Eye Unit between June 2013 and June 2014. Patients were either switched from pro re nata (PRN) ranibizumab/bevacizumab due to poor response (107 eyes), or treatment-naïve (58 eyes). Patients received 3 initial monthly intravitreal aflibercept injections followed by 2-monthly fixed doses. Clinic visits were scheduled at months 0, 4, 10 and 12. Mean change in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) from baseline were assessed using the Wilcoxon signed-rank test. The proportion of patients maintaining BCVA (<15 letters loss) at 12 months was also evaluated.

Results: Mean BCVA change at month 12 was +3.29 and +4.67 letters in the switched and naïve aflibercept groups respectively (p<0.01). BCVA was maintained in 95.3% of switched and 96.6% of naïve patients. CRT at month 12 showed a decrease of -6.16µm in the switched group and -35.36µm decrease in the naïve group (p<0.01). Patients previously treated with ranibizumab/bevacizumab had on average received 7.4 ranibizumab/bevacizumab injections over 12.6 months, attending 10 clinic visits. The fixed dosing aflibercept regimen required an average of 7.13 injections (naïve group), 7.5 injections (switched group) and 4 clinic visits per year.

Conclusion: Fixed bimonthly aflibercept is effective in both treatment-naïve and poorly responsive nvAMD patients. Adopting a fixed dosing regimen can reduce patient burden without compromising on outcomes.
age-related macular degeneration, neovascular, aflibercept, ranibizumab
2222-3959
1156-1162
Warwick, Alasdair
efe63330-ed24-4dfe-8c88-c3f6dbf828ed
Leaver, Hannah
097d7f3a-6c66-4f94-94ae-e856f2e20561
Lotery, Andrew
5ecc2d2d-d0b4-468f-ad2c-df7156f8e514
Goverdhan, Srini
9ae32d5a-5c82-48a4-962d-1ed8acc3991e
Warwick, Alasdair
efe63330-ed24-4dfe-8c88-c3f6dbf828ed
Leaver, Hannah
097d7f3a-6c66-4f94-94ae-e856f2e20561
Lotery, Andrew
5ecc2d2d-d0b4-468f-ad2c-df7156f8e514
Goverdhan, Srini
9ae32d5a-5c82-48a4-962d-1ed8acc3991e

Warwick, Alasdair, Leaver, Hannah, Lotery, Andrew and Goverdhan, Srini (2016) Fixed bimonthly aflibercept in naïve and switched neovascular age related macular degeneration patients: 1 year outcomes. International Journal of Ophthalmology, 9 (8), 1156-1162. (doi:10.18240/ijo.2016.08.12).

Record type: Article

Abstract

Aim: To determine real life clinical outcomes in poorly responsive and treatment-naïve neovascular age related macular degeneration (nvAMD) patients using bi-monthly fixed dosing aflibercept regimen.

Methods: This was a retrospective study of 165 eyes with nvAMD started on aflibercept at Southampton Eye Unit between June 2013 and June 2014. Patients were either switched from pro re nata (PRN) ranibizumab/bevacizumab due to poor response (107 eyes), or treatment-naïve (58 eyes). Patients received 3 initial monthly intravitreal aflibercept injections followed by 2-monthly fixed doses. Clinic visits were scheduled at months 0, 4, 10 and 12. Mean change in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) from baseline were assessed using the Wilcoxon signed-rank test. The proportion of patients maintaining BCVA (<15 letters loss) at 12 months was also evaluated.

Results: Mean BCVA change at month 12 was +3.29 and +4.67 letters in the switched and naïve aflibercept groups respectively (p<0.01). BCVA was maintained in 95.3% of switched and 96.6% of naïve patients. CRT at month 12 showed a decrease of -6.16µm in the switched group and -35.36µm decrease in the naïve group (p<0.01). Patients previously treated with ranibizumab/bevacizumab had on average received 7.4 ranibizumab/bevacizumab injections over 12.6 months, attending 10 clinic visits. The fixed dosing aflibercept regimen required an average of 7.13 injections (naïve group), 7.5 injections (switched group) and 4 clinic visits per year.

Conclusion: Fixed bimonthly aflibercept is effective in both treatment-naïve and poorly responsive nvAMD patients. Adopting a fixed dosing regimen can reduce patient burden without compromising on outcomes.

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Aflibercept Final Accepted.pdf - Accepted Manuscript
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More information

Accepted/In Press date: 28 January 2016
e-pub ahead of print date: 18 August 2016
Published date: 18 August 2016
Keywords: age-related macular degeneration, neovascular, aflibercept, ranibizumab
Organisations: Clinical & Experimental Sciences

Identifiers

Local EPrints ID: 388355
URI: https://eprints.soton.ac.uk/id/eprint/388355
ISSN: 2222-3959
PURE UUID: 61d0deca-3256-4d13-884f-2fa3833b6012
ORCID for Andrew Lotery: ORCID iD orcid.org/0000-0001-5541-4305

Catalogue record

Date deposited: 24 Feb 2016 14:31
Last modified: 10 Dec 2019 01:46

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