Aflibercept shows efficacy over bevacizumab at weaning patients with wet AMD off treatment
Click Here to Manage Email Alerts
Eyes with neovascular age-related macular degeneration treated with aflibercept were almost three times more likely to be weaned off treatment after 1 year compared with those treated with bevacizumab, according to a study.
“We confirm that using aflibercept can result in a longer treatment interval and fewer injections using a treat-and-extend approach compared to bevacizumab,” the study authors wrote. “Conversely, while the number of treatments was slightly higher for the bevacizumab group, the final [central subfield thickness] and the final visual acuity was similar at 1 year regardless of the choice of drug.”
The retrospective analysis included 122 eyes of 106 patients with neovascular AMD that underwent three consecutive monthly injections with aflibercept (70 eyes) or bevacizumab (52 eyes). The 3-month treatment was followed by a treat-and-extend protocol based on visual acuity, clinical exam, and the presence or absence of fluid on OCT.
More eyes treated with aflibercept were successfully weaned off treatment at 1 year compared with eyes treated with bevacizumab, 43% vs. 15%, respectively (P < .0001). Additionally, despite similar vision outcomes across both treatments, eyes treated with bevacizumab required more injections at the end of 1 year compared with eyes treated with aflibercept, 8.7 ± 0.3 vs. 7.2 ± 0.3, respectively (P = .002).
Of those eyes followed out to 2 years, 52% treated with aflibercept were successfully weaned off treatment compared with 27% treated with bevacizumab.
A limitation of the study was that patients were not randomly assigned to either aflibercept or bevacizumab but were given the choice between the two treatments.
“The observation that the early response to treatment with aflibercept was significantly greater than the response to bevacizumab, and that this correlated with the improved efficacy of aflibercept over bevacizumab at weaning patients off treatment, suggests that there may be an unexpected long-term advantage to starting patients on treatment with aflibercept,” the study authors wrote. “The observation that 43% of eyes of [neovascular] AMD patients treated with aflibercept could achieve a treatment pause within 1 year (and half of eyes by the end of the second year) further suggests many [neovascular] AMD patients may not require — or benefit from — the anticipated introduction of second-generation, longer-acting anti-VEGF therapies or alternative delivery techniques (eg, surgical implantation of an anti-VEGF reservoir).”
For more on this topic, please see the commentary from Andrew A. Moshfeghi, MD, MBA.
Collapse
Read more about
Click Here to Manage Email Alerts