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Ophthalmology. 2016 Sep;123(9):1856-64. doi: 10.1016/j.ophtha.2016.05.016. Epub 2016 Jun 28.

Differential Response to Anti-VEGF Regimens in Age-Related Macular Degeneration Patients with Early Persistent Retinal Fluid.

Author information

1
Department of Ophthalmology, Duke University, Durham, North Carolina. Electronic address: glenn.jaffe@duke.edu.
2
Cole Eye Institute, Cleveland, Ohio.
3
Regeneron Pharmaceuticals, Inc., Tarrytown, New York.
4
Ophthalmic Consultants of Boston, Boston, Massachusetts.

Abstract

PURPOSE:

To compare the effect of intravitreal aflibercept or ranibizumab drug type and frequency on visual acuity outcomes in eyes with neovascular age-related macular degeneration (NVAMD) and early persistent retinal fluid after 3 initial monthly injections.

DESIGN:

A post hoc analysis of eyes enrolled in VIEW 1 and VIEW 2, 2 similarly designed, randomized, phase 3 trials.

PARTICIPANTS:

A total of 1815 eyes with NVAMD from VIEW 1 and VIEW 2.

METHODS:

Analyses included patients with known fluid status at baseline and weeks 4, 8, and 12 in 3 treatment groups: ranibizumab 0.5 mg every 4 weeks (Rq4) (n = 595), intravitreal aflibercept injection (IAI) 2 mg every 4 weeks (2q4) (n = 613), and IAI 2 mg every 8 weeks (2q8) after 3 monthly injections (n = 607).

MAIN OUTCOME MEASURES:

Mean best-corrected visual acuity (BCVA) change from baseline over weeks 16 to 52 and the proportion of eyes that gained ≥15 letters or lost ≥5 letters were evaluated in eyes with and without persistent fluid (cystic intraretinal or subretinal fluid at all 4 initial visits). Visual outcomes also were assessed in eyes with persistent fluid by fluid type (intraretinal and subretinal fluid).

RESULTS:

The proportions of eyes with persistent fluid were 29.4%, 18.8%, and 20.3% in the Rq4, 2q4, and 2q8 groups, respectively. In these eyes, mean BCVA gain from baseline to week 52 was greater with 2q4 compared with Rq4 (P < 0.01) and 2q8 (P < 0.05), whereas it was similar with Rq4 and 2q8 (P = 0.294). At week 52, similar proportions of eyes gained ≥15 letters (31.5%-35.2%), whereas fewer eyes lost ≥5 letters with 2q4 compared with Rq4 and 2q8 (6.5% vs. 16.6% and 16.2%). The pattern of visual outcomes was similar regardless of fluid type. In eyes without persistent fluid, BCVA changes were similar across treatment groups.

CONCLUSIONS:

In patients with early persistent fluid, 2q4 may provide additional clinical benefit over 2q8 or Rq4.

PMID:
27369111
DOI:
10.1016/j.ophtha.2016.05.016
[Indexed for MEDLINE]
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