Wet AMD: Aflibercept Best at Reducing Severe Increases in Pigment Epithelial Detachment Height

Researchers compared aflibercept, bevacizumab, and ranibizumab injections.

A retrospective comparison of intravitreal aflibercept, bevacizumab, and ranibizumab injections revealed outcomes in patients with neovascular age-related macular degeneration (nAMD).

A South Korean team found similar responses with each agent, however, aflibercept treatment required fewer injections than the other anti-vascular endothelial growth factor (VEGF) agents did. Moreover, the investigators noted that aflibercept decreased the size of pigment epithelial detachment (PED) significantly more quickly than bevacizumab did.

In the study, Dae Hyun Park, MD, and colleagues from the Department of Ophthalmology in the College of Medicine at Soonchunyang University in Seoul, South Korea examined 232 eyes of 232 patients with nAMD who had not been treated previously with anti-VEGF agents. All patients received intravitreal injections of anti-VEGF agents for the first three months, were injected as needed thereafter, and were followed up for at least one year.

The investigators evaluated the effects of treatment on central macular thickness, subretinal fluid, PED size, and best-corrected visual acuity (BCVA). After anti-VEGF treatment, they found statistically significant decreases in all three anatomical measures as well as in the logMAR of BCVA.

In general, the investigators found no statistically significant differences in responses to treatment among the three anti-VEGF agents studied, except in the speed of reduction in PED size. More specifically, aflibercept treatment decreased PED size faster than bevacizumab treatment did (P = 0 .034). This finding led the investigators to conclude, “Aflibercept injections may be a better choice than other anti-VEGF agents for cases of severe increases in PED height.”

This conclusion, as well as the superior performance of aflibercept in shrinking PED size found in this study, is supported by findings from an earlier study that quantified the change in PED volume in 10 patients with nAMD refractory to monthly intravitreal bevacizumab or ranibizumab who were switched to intravitreal aflibercept treatment for 18 months.

In that retrospective case series, researchers from Northwestern University Feinberg School of Medicine in Chicago, Illinois examined 11 eyes with nAMD and persistent fibrovascular or serous PED identified by using spectral-domain optical coherence tomography (SD-OCT). They then calculated PED volume by manually outlining the PED on individual OCT slices of the raster scan and multiplying by the pixel dimensions.

Using this painstaking method, the Northwestern team found that aflibercept reduced PED volume by 19% ± 12% while preserving visual acuity. Moreover, this decrease was significant at a level of P = 0.02.

The study, “A comparison of responses to intravitreal bevacizumab, ranibizumab, or aflibercept injections for neovascular age-related macular degeneration,” recently appeared online in International Ophthalmology.

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