Abstract
PurposeTo investigate the visual and anatomical outcomes associated with treat-and-extend (TAE) regimen of intravitreal (IVT) aflibercept in eyes with treatment naïve neovascular age-related macular degeneration (nvAMD).MethodsA retrospective chart review of eyes that underwent IVT aflibercept injections for nvAMD between May 2014 and March 2018 was performed. The primary outcome was the change in best corrected visual acuity (BCVA) at 12 months. Secondary outcomes included the change in central retinal thickness (CRT), subretinal fluid (SRF) and intraretinal fluid (IRF).ResultsData from 213 eyes of 213 patients (138 female, 65%) met the inclusion criteria. The mean (SD) age of the patients was 80.4 (± 9.2) years. The mean baseline BCVA (0.92 ± 0.50 logMAR, improved by 0.20 (± 0.40) logMAR units at 12 months (p < 0.001). Seventy-two (34%) eyes gained ≥ 0.3 logMAR and 47 (22%) eyes achieved BCVA ≤ 0.3 logMAR at 12 months. Baseline BCVA, patient age, and the number of aflibercept injections received were predictors of the change in BCVA at 12 months. Mean CRT improved from 347 (± 117) µm at baseline to 246 (± 55) µm at 12 months (p < 0.001). The percentage of eyes with SRF and IRF on SD-OCT declined from 63 to 21% and from 60 to 26% at 12 months, respectively.ConclusionA TAE regimen of IVT aflibercept in treatment naïve nvAMD is associated with good visual and anatomical outcomes in routine clinical practice. Resolution of exudation occurred in about half of nvAMD cases at 12 months. Individualized administration of IVT aflibercept may reduce injection burden.
Highlights
Aflibercept or vascular endothelial growth factor (VEGF) Trap-eye (Eylea; Regeneron Pharmaceuticals), is a VEGFbinding recombinant fusion protein that demonstrated stronger VEGF binding affinity than antibody-mediatedVEGF inhibition [1] and down-regulates plasma von Willebrand factor [2].In the VIEW 1 and VIEW 2 trials, intravitreal (IVT) administration of aflibercept (2 mg) at 1- and 2-month intervals was associated with significant visual improvement in patients with neovascular age-related macular degeneration [3]
Data from prospective randomized clinical studies have suggested that TAE dosing of aflibercept may enable comparable visual and anatomical improvements to those observed with fixed dosing [5, 6]
We conducted the current study surveying a large sample of eyes with treatment naïve neovascular age-related macular degeneration (nvAMD) to evaluate the visual and anatomical outcomes of IVT aflibercept using a TAE protocol in routine clinical setting
Summary
Aflibercept or vascular endothelial growth factor (VEGF) Trap-eye (Eylea; Regeneron Pharmaceuticals), is a VEGFbinding recombinant fusion protein that demonstrated stronger VEGF binding affinity than antibody-mediatedVEGF inhibition (i.e., ranibizumab and bevacizumab) [1] and down-regulates plasma von Willebrand factor [2].In the VIEW 1 and VIEW 2 trials, intravitreal (IVT) administration of aflibercept (2 mg) at 1- and 2-month intervals (following three monthly injections) was associated with significant visual improvement in patients with neovascular age-related macular degeneration (nvAMD) [3]. The visual outcomes and frequency of injections associated with TAE aflibercept dosing varies widely between these studies Perhaps this variation stems from differences in sample size, baseline characteristics and treatment criteria among different studies [7,8,9,10,11,12,13,14,15,16]. With this in mind, we conducted the current study surveying a large sample of eyes with treatment naïve nvAMD to evaluate the visual and anatomical outcomes of IVT aflibercept using a TAE protocol in routine clinical setting
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