Korean J Ophthalmol.  2015 Aug;29(4):226-232. 10.3341/kjo.2015.29.4.226.

Aflibercept Treatment for Neovascular Age-related Macular Degeneration and Polypoidal Choroidal Vasculopathy Refractory to Anti-vascular Endothelial Growth Factor

• Moon DR
• Lee DK
• Kim SH
• You YS
• Kwon OW

• KMID: 2363766
• DOI: http://doi.org/10.3341/kjo.2015.29.4.226

Abstract

PURPOSE
To report the results of switching treatment to vascular endothelial growth factor (VEGF) Trap-Eye (aflibercept) in neovascular age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) refractory to anti-VEGF (ranibizumab and bevacizumab).
METHODS
This is a retrospective study involving 32 eyes from 29 patients; 18 were cases of neovascular AMD and 14 were cases of PCV. The best-corrected visual acuity (BCVA) and central macular thickness (CMT) of spectral-domain optical coherence tomography were evaluated.
RESULTS
BCVA and CMT improved from 0.58 to 0.55 (p = 0.005) and from 404 to 321 microm (p < 0.001), respectively, after switching to aflibercept. The 14 eyes that received 6 or more aflibercept injections remained stable at 0.81 to 0.81 and 321 to 327 microm (p = 1.0, 0.29), respectively, after 3 aflibercept injections. The 10 eyes that received 3 or more bevacizumab injections after 3 or more aflibercept injections worsened, from 0.44 to 0.47 and from 332 to 346 microm (p = 0.06, 0.05), respectively. The results showed similar improvement of BCVA and CMT in neovascular AMD and PCV.
CONCLUSIONS
Aflibercept seems to be effective for improvement and maintenance of BCVA and CMT for neovascular AMD and PCV refractory to anti-VEGF. Switching from aflibercept back to bevacizumab treatment may not be a proper strategy.

Keyword

Aflibercept; Anti-vascular endothelial growth factor; Bevacizumab; Macular degeneration; Polypoidal choroidal vasculopathy

MeSH Terms

Angiogenesis Inhibitors/administration & dosage
Bevacizumab/administration & dosage
Choroid/*blood supply
Choroid Diseases/complications/diagnosis/*drug therapy
Dose-Response Relationship, Drug
Drug Therapy, Combination
Female
Follow-Up Studies
Humans
Intravitreal Injections
Male
Ranibizumab/administration & dosage
Receptors, Vascular Endothelial Growth Factor/*administration & dosage
Recombinant Fusion Proteins/*administration & dosage
Retinal Neovascularization/complications/diagnosis/*drug therapy
Retrospective Studies
Tomography, Optical Coherence
Treatment Outcome
Vascular Endothelial Growth Factor A/*antagonists & inhibitors
*Visual Acuity
Wet Macular Degeneration/diagnosis/*drug therapy/etiology
Angiogenesis Inhibitors
Bevacizumab
Ranibizumab
Receptors, Vascular Endothelial Growth Factor
Recombinant Fusion Proteins
Vascular Endothelial Growth Factor A

Figure

• 

  Fig. 1 Changes in mean best-corrected visual acuity (logarithm of the minimal angle of resolution, logMAR) for all cases including on-going and switching-back cases during the entire follow-up period. 2.7 months was the time point after 3 initial loading injections of aflibercept in all cases. 4.2 months was the time point of 4 or more on-going treatment of aflibercept in 14 cases. 4.6 months was the time point of switching-back treatment of bevacizumab in 10 cases. Improvement of best-correct visual acuity from baseline of all cases was statistically significant, but not significant in on-going or switching-back treatment cases during the entire follow-up period. Best-correct visual acuity was stable in on-going cases (p = 1.0) but deteriorated in switching-back cases (p = 0.06). VA = visual acuity. *p < 0.05.

• 

  Fig. 2 Changes in mean central macular thickness (CMT) of all cases, on-going cases, and switching-back cases during the entire follow-up period. 4.2 months was the time point of 4 or more on-going treatments of aflibercept in 14 cases. 4.6 months was the time point of switching-back treatment of bevacizumab in 10 cases. Improvement of CMT from baseline in all cases, including on-going and switching-back cases, was statistically significant during the entire follow-up period. However, after switching back to bevacizumab, CMT increased (p = 0.05) during the switching-back period. In contrast, CMT remained stable in on-going 4 or more treatment cases of aflibercept (p = 0.29) during the treatment period. *p < 0.05.

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