Abstract
Intravitreal aflibercept (IVT-AFL) is an effective treatment for wet age-related macular degeneration (wAMD), a leading cause of blindness. The efficacy and safety of IVT-AFL have been established in randomised studies, but there is growing interest in how IVT-AFL is used in clinical practice and the real-world outcomes achieved. The aim of this study was to examine this in detail. A systematic literature review (SLR) and a meta-analysis (MA) of prospective, observational studies enrolling treatment-naïve patients with wAMD that initiated treatment with IVT-AFL were performed. Variables of interest included age and visual acuity (VA) at baseline, VA change, and number of injections and visits at 52 weeks. SLR followed MOOSE guidelines and MA included fixed- and random-effects models (heterogeneity was measured using I2). Data from 7 studies and 5331 treatment-naïve patients were analysed. Based on random-effects model, the mean age was 79.41 [95% confidence interval (CI), 78.342–80.48] and mean VA (ETDRS letters) was 55.52 [95% CI, 54.33–56.70] at baseline. The mean change in VA (letters) at 52 weeks was 5.54 [95% CI, 5.00–6.08; I2=14.95%]. The mean number of IVT-AFL injections was 7.03 [95% CI, 6.38–7.69] and the mean number of visits (injection and monitoring) was 8.26 [95% CI, 7.47–9.05] at 52 weeks. This analysis describes real-world use and outcomes associated with IVT-AFL treatment in wAMD naïve patients. IVT-AFL was associated with an improvement in VA at 52 weeks with a low degree of heterogeneity across studies. The mean number of IVT-AFL injections suggests that IVT-AFL was used in accordance with the European prescribing information in wAMD (ie, 3 initial doses every 4 weeks followed by dosing every 8 weeks over the first 52 weeks). These findings confirm that real-world outcomes with IVT-AFL are consistent with those observed in randomised studies, such as VIEW.
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