Switch to Eylea reduces fluid, improves visual acuity in eyes with wet AMD

Fluid was reduced and visual acuity was improved in eyes with neovascular age-related macular degeneration that received Eylea after multiple intravitreal injections of Avastin or Lucentis, according to a study.

Perspective from Andrew P. Schachat, MD

The retrospective study included 31 eyes of 31 patients with neovascular AMD who responded poorly to Lucentis (ranibizumab 0.5 mg, Genentech) and/or Avastin (bevacizumab 1.25 mg, Genentech) and were switched to Eylea (aflibercept 2 mg, Regeneron).

All eyes underwent scanning with spectral-domain OCT. Investigators evaluated volume scans on the last two visits before the therapy switch, at the time of the switch, at least 4 weeks after the switch and after three injections of aflibercept.

The mean number of previous anti-VEGF injections was 18.

Bevacizumab had been used exclusively in two eyes and ranibizumab exclusively in 11 eyes. Eighteen eyes received both bevacizumab and ranibizumab during the course of treatment.

After the switch to aflibercept, neurosensory retinal volume decreased 0.32 mm3 (P = .01), subretinal fluid decreased 0.08 mm³ (P = .04), and pigment epithelial detachment decreased 0.56 mm³ (P = .001).

Mean ETDRS visual acuity increased from 62 to 65 letters (P = .04).

“These favorable outcomes were sustained after three monthly injections of the new drug,” the study authors said. – by Matt Hasson

Disclosure: Sadda reports he is a consultant for Carl Zeiss Meditec, Allergan, Regeneron, Optos and Optovue. The remaining authors report no relevant financial disclosures.

Perspective

Andrew P. Schachat, MD

Hariri and colleagues studied subjects switched to aflibercept therapy in 40 eyes with persistent fluid after multiple intravitreal injections of bevacizumab or ranibizumab. They found an early reduction in all fluid compartments and improvement in visual acuity. Switched patients had had a “suboptimal response” with bevacizumab or ranibizumab, as evidenced by persistent fluid despite three or more monthly injections. Of course, if subjects had not been switched, improvement with the ongoing initial therapy might have been seen. As the authors correctly noted, their findings corroborated the results of other groups that observed favorable anatomic effects of switching to aflibercept therapy, although the current study is unique in that the authors quantitatively analyzed the response in individual subcompartments of the retina. We are blessed with a number of well-done randomized studies that compare anti-VEGF drugs for the treatment of neovascular age-related macular degeneration. Well-done case series such as this one provide a basis for future randomized trials that study “switching.”

Andrew P. Schachat, MD

Vice Chairman for Clinical Affairs, Cole Eye Institute

Disclosures: Schachat reports he has financial relationships with AnGes, Easton Capital and Elsevier.

Published by:

Sources/Disclosures

Collapse

Source: Hariri A, et al. Ophthalmic Surg Lasers Imaging. 2015;doi:10.3928/23258160-20150213-18.