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Specialist discusses suboptimal results of anti-VEGF therapy, switching treatment in non-responders

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BASSANO DEL GRAPPA, Italy — Variable results, inferior to what could be expected from anti-VEGF therapy for age-related macular degeneration, are observed in the real world of clinical practice, according to one specialist.

In addition, criteria for classifying non-responders and switching them to another anti-VEGF drug should be clarified.

Daniele Veritti

“It is true that our patients do not comply with the inclusion criteria of clinical trials, but in many cases, the inferior outcomes are due to inadequate treatment,” Daniele Veritti, MD, said at the Bassano Ophthalmology Meeting.

“While patients should be treated immediately, or at least within 15 days, when signs of an active lesion are found, very few centers have a waiting list shorter than 1 month. Also, the results of PRN treatment, which is the most commonly used regimen, are highly dependent on the physician skills and on the technology used to examine the patient. Spectral-domain OCT can detect signs that time-domain is unable to show,” he said.

Non-responders should be recognized promptly and switched immediately to an alternative agent, Veritti said. In many cases, patients cease to respond to treatment because they develop intolerance or tachyphylaxis. The switch from Lucentis (ranibizumab, Genentech/Novartis) or Avastin (bevacizumab, Genentech/Roche) to Eylea (aflibercept, Regeneron/Bayer) has been shown effective in many reported cases.

“We are currently on our way to publish a study involving three centers in Europe. A total of 92 patients who had lost six letters in the previous 6 months of treatment with ranibizumab regained five letters almost immediately after the switch to aflibercept. A slight loss was observed within the following 12 months, but the gain remained significant,” Veritti said.

He noted that this study is unique because it included patients who were treated well in the previous 6 months, with a mean of 5.2 injections, and followed for 1 year after switching to aflibercept.

Disclosure: Veritti reports no relevant financial disclosures.