July 27, 2019
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At 2 years, aflibercept injections did not impact CNV conversion rates

Jeffrey S. Heier

CHICAGO — The 24-month results of the PRO-CON study did not demonstrate a benefit of intravitreal aflibercept injection as prophylaxis against the conversion to neovascular age-related macular degeneration in high-risk eyes, according to a speaker here.

“Quarterly aflibercept prophylaxis did not affect conversion through month 24 in the PRO-CON trial,” Jeffrey S. Heier, MD, said at the American Society of Retina Specialists meeting.

The PRO-CON trial enrolled 128 eyes with high risk, intermediate AMD to evaluate intravitreal anti-VEGF therapy and its potentially prophylactic effect against the conversion to wet AMD. High risk intermediate AMD was defined as having more than 10 intermediate sized drusen (between 63 µm and 125 µm), one or more large drusen (125 µm or greater), and or retinal pigmentary changes. Additionally, all subjects had wet AMD in their fellow eye, he said.

Eyes were randomized 1:1 to receive either quarterly treatment with intravitreal aflibercept injection (Eylea, Regeneron) or sham injection. The primary endpoint of the study was proportion of patients converting to wet AMD at 24 months, he said.

At 24-months, 6.35% of intravitreal aflibercept injection (IAI) patients converted to wet AMD compared with 9.38% of sham injection patients. Additionally, 6% of IAI and sham patients with more than two years of exudative disease in the fellow converted to wet AMD. This is compared to 13% of IAI patients and 16% of sham patients with less than two years of exudative disease in the fellow eye converted to wet AMD.

Patients with non-exudative CNV confirmed on OCTA were found to have a higher wet AMD conversion rate in either group. Researchers found 27% of IAI patient with non-exudative CNV converted to wet AMD compared with 31% of sham patients, he said.

Finally, the development or progression of geographic atrophy was not found to be affected by quarterly aflibercept treatment, he said.

by Robert Linnehan

 

Reference: Heier JS. Prophylaxis Intravitreal Aflibercept Against Conversion to Neovascular Age-Related Macular Degeneration in High Risk Eyes (PRO-CON): 24-Month Results. Presented at: American Society of Retina Specialists annual meeting; July 27-30, 2019; Chicago.

Disclosure: Heier reports he is a consultant for Regeneron, Genentech, Novartis and Optovue.