Tackling Treatment-Resistant Neovascular AMD with Intravitreal Aflibercept
In Australia, researchers sought to assess the effectiveness of intravitreal aflibercept in patients with neovascular age-related macular degeneration (AMD) previously resistant to treatment with other anti-vascular endothelial growth factor (VEGF) agents.
They conducted this prospective, open-label, noncontrolled, registered clinical trial, which included 49 patients with treatment-resistant neovascular AMD. They administered a dose of 2 mg intravitreal aflibercept as three initial loading doses every four weeks (week zero, week four and week eight), followed by further injections every eight weeks (weeks 16 and 24) across a 24-week period in total. All patients underwent a complete ophthalmic examination, including measurement of Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA), intraocular pressure (IOP) assessment, adverse event monitoring and spectral-domain optical coherence tomography at every visit. The study researchers also performed baseline fluorescein angiography and indocyanine green angiography. Outcomes assessed included proportions of patients with a gain or loss of more than five ETDRS letters and a decrease or increase in central retinal thickness (CRT) of more than 150 µm at week 24 compared with baseline, change in mean BCVA and CRT between baseline and week 24, and descriptive safety data.
According to the researchers, the BCVA improved and CRT was reduced significantly at all follow-up visits compared with baseline (p<0.001), with a mean improvement of 6.9 letters of BCVA and a decrease of 89.4 µm in CRT at week 24. They reported that spacing of injections from every four weeks to eight weeks resulted in an increase of 37.4 µm in CRT (p<0.001); however, this was not correlated with a significant change in vision. There was one (2%) patient who lost more than five ETDRS letters, and 27 (55%) patients who gained more than five letters. Two (4%) patients had a more than 150 µm increase in CRT at week 24, and 10 (20%) patients showed a decrease in CRT of more than 150 µm.
In conclusion, intravitreal aflibercept is effective in previously treatment-resistant neovascular AMD. Further follow-up is required to determine whether these improvements can be maintained.