Intravitreal Aflibercept (VEGF Trap-Eye) in Wet Age-related Macular Degeneration
Jeffrey S. HeierDavid M. BrownVictor ChongJean‐François KorobelnikPeter K. KaiserQuan Dong NguyenBernd KirchhofAllen C. HoYuichiro OguraGeorge D. YancopoulosNeil StahlRobert VittiAlyson J. BerlinerYuhwen SooMajid AnderesiGeorg GroetzbachBernd SommerauerRupert SandbrinkChristian SimaderUrsula Schmidt‐Erfurth
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Abstract Given the rising prevalence of patients with diabetes and increasing treatment burden for patients with vision-threatening diabetic macular edema (DME), we aimed to explore the efficacy of modified early intensive and treat-and-extend regimen of anti-vascular endothelial growth factor (VEGF) therapy under the Taiwan National Insurance Bureau reimbursement policy. We obtained data on 69 eyes treated with initial 4-monthly intravitreal injections of aflibercept or ranibizumab, plus individualized treat-and-extend regimen. At 12 months, the mean (SD) change in LogMAR best corrected visual acuity from baseline was − 0.28 (0.31) in all eyes, while that in the aflibercept and ranibizumab groups were − 0.30 (0.34) and − 0.25 (0.28), respectively. Central retinal thickness decreased by 137.2 (122.4) in all eyes, 138.1 (134.2) in the aflibercept group, and 136.2 (110.9) in the ranibizumab group. Additionally, the aflibercept group had a lower mean number of injections than the ranibizumab group (8.5 vs. 8.7). The last extended dosing interval of > 12 weeks was 31.0% and 16.7% of the eyes in the aflibercept and ranibizumab groups, respectively. The modified anti-VEGF regimens effectively managed DME in terms of functional and anatomical outcomes, and efficiently reduced the healthcare burden by reducing the number of injections and extending treatment intervals within 12 months.
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Pathologic myopia is the second cause of choroidal neovascularization(CNV),after age-related macular degeneration,and the first cause in patients younger than 50 years.During recent years,anti-vascular endothelial growth factor drugs are now widely used not only to treat CNV in age-related macular degeneration but for myopic CNV,and show good results.This article reviews recent treatment advances in intravitreal injection of ranibizumab for myopic CNV.
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Introduction: Wet age-related macular degeneration (AMD) is a potentially blinding eye disease that causes vision loss among individuals > 50 years old. The main goal in the treatment of wet AMD is to inhibit the choroidal neovascularization (CNV). Currently, ranibizumab and aflibercept are two available anti-VEGF drug for the treatment of wet AMD. Here, we reviewed the clinical outcome of treatment with ranibizumab or aflibercept in patients with wet AMD from recent studies with a special focus on eyes with unusual presentations or treatment resistant and compared these agents with other available wet AMD therapies.Areas covered: For this review, a literature search from 2011 to present was performed using the following terms (or combination of terms): anti-vascular endothelial growth factors, anti-VEGF, age-related macular degeneration, AMD, aflibercept, and ranibizumab. The studies were limited to studies used ranibizumab, and especially those switched from ranibizumab to aflibercept. Also the clinical trial website (www.clinicaltrials.gov) was searched for recently completed trials of aflibercept or ranibizumab for wet AMD treatment.Expert opinion: Ranibizumab and aflibercept are effective for the treatment of wet AMD including those with retinal angiomatous proliferation (RAP) and CNV unresponsive to other anti-VEGF agents. Although high-dose ranibizumab has the potential to treat unresponsive CNV, switching to another anti-VEGF agent may be a preferable option in these eyes.
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Abstract: Age-related macular degeneration (AMD) is the most common cause of legal blindness in developed countries. Neovascular (ie, wet) AMD is currently managed with intravitreal therapy. Traditional treatments (ie, bevacizumab, ranibizumab, aflibercept) provide high-efficacy therapy but can also require frequent dosing. Newer and future anti-VEGF therapies aim to decrease injection frequency through eitherlonger half life or port-delivery systems (brolucizumab, conbercept, KSI-301, ranibizumab). This review outlines current anti-VEGF treatments and ways by which their duration might be extended. Keywords: anti-VEGF, wet age-related macular degeneration, brolucizumab, aflibercept, bevacizumab, ranibizumab, KSI-301
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The intravitreal anti-vascular endothelial growth factor treatments ranibizumab and aflibercept have proven efficacy in clinical trials, but their real world usage in central retinal vein occlusion (CRVO) has not been assessed. We therefore evaluated the treatment patterns of both drugs in a US claims database. The IMS Integrated Data Warehouse was used to identify the patients with CRVO in the USA with claims for ranibizumab or aflibercept between 24 September 2012 and 31 March 2014 with at least 12 months follow-up. Patients were required to have had no anti-VEGF treatment code for 6 months before index (‘treatment-naive’). Mean numbers of injections and non-injection visits to a treating physician were compared with patients receiving these treatments. Patient characteristics were similar for patients receiving ranibizumab (n=206) or aflibercept (n=79) at index. The mean (±SD) numbers of injections received by patients treated with ranibizumab or aflibercept were 4.4±2.8 and 4.7±2.9 (P=0.38), respectively; the total number of patient visits to their treating physician was 7.3±3.7 and 7.0±2.9 (P=0.52), respectively. For patients receiving one or more injections (n=238), the mean interval between injections was 55.1 days (ranibizumab) and 54.2 days (aflibercept; P=0.44). Our results suggest that, in routine clinical practice, patients receive a comparable number of injections in the first year of treatment with ranibizumab or aflibercept. This may have implications for commissioning and service development of CRVO care pathways.
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Purpose: To compare the visual and anatomical outcomes between intravitreal aflibercept and ranibizumab for diabetic macular edemaMethods: A total of 194 eyes from 194 patients (aflibercept n = 95, ranibizumab n = 99) were retrospectively enrolled in the study. All eyes fulfilled the key criteria including a baseline best-corrected visual acuity (BCVA) between 20 and 70 ETDRS letters, a central subfield thickness (CST) 300 µm or more. Primary outcomes were BCVA and CST at 1, 3, 6, and 12 months. Maintenance of vision was defined as visual loss of less than 5 letters over 6 to 12 months. Predictors for final visual acuity and visual maintenance were analyzed using multivariate regression models.Results: Both agents achieved comparable visual and anatomical outcomes at any time point over the course of follow-up (all p > .05). At 12 months, aflibercept group had higher proportions of visual gains 5, 10 and 15 letters or more (p = .014, p = .011, and p = .034, respectively). The mean number of injections was 5.0 ± 1.9 in ranibizumab group and 4.5 ± 1.9 in aflibercept group (p = .09). Ranibizumab predicted poor maintenance of vision (p = .009), but not the final visual acuity (univariate p = .1). Ranibizumab was more likely to have recurrence of subretinal fluid than aflibercept in 12 months after resolution of subretinal fluid at baseline (p = .016). Both aflibercept and ranibizumab had similar rates of loss to follow-up (p = .47) and occurrence of vitreous hemorrhage (p = .21).Conclusion: While both agents improved vision with resolution of edema, aflibercept maintained vision more effectively with less recurrence of subretinal fluid at 12 months in real-world settings.
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