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Switch to aflibercept or ranibizumab after initial treatment with bevacizumab in eyes with neovascular AMD.
BMC Ophthalmol 2017; 17(1):79BO

Abstract

BACKGROUND

To evaluate changes in central macular thickness (CMT) and visual outcome in patients with neovascular age-related macular degeneration (AMD) treated initially with bevacizumab and subsequently switched to either aflibercept or ranibizumab.

METHODS

Observational clinical study was performed. We measured the structural outcome (CMT on SD-OCT; μm) and the visual outcome (best corrected visual acuity (BCVA); logMAR), as follows: before treatment (at baseline), following bevacizumab treatment (switch follow-up) and after switching from bevacizumab to aflibercept- or ranibizumab treatment (final follow-up, AG/, RG).

RESULTS

From a total of 96 eyes treated with intravitreal injections of bevacizumab (10.5 ± 7.6 (mean ± SD)), 58 eyes switched to aflibercept (6.5 ± 3.9; AG) and 38 eyes switched to ranibizumab (7.1 ± 5.3; RG) (≥ 3 injections, each). In addition, these eyes were compared to 37 eyes under bevacizumab monotherapy.

PRIMARY OUTCOME

In the AG, the CMT decreased slightly from 430 ± 220 μm at baseline to 419 ± 212 μm at switch follow-up (p = 0.86), but decreased significantly to 318 ± 159 μm at final follow-up, AG (p < 0.0001). In the ranibizumab group (RG), the CMT increased from 396 ± 174 μm at baseline to 499 ± 333 μm at switch follow-up (p = 0.012), but decreased significantly to 394 ± 202 μm at final follow-up, RG (p = 0.007). Secondary outcome: In the AG, the mean BCVA worsened from logMAR 0.57 ± 0.33 at baseline to 0.63 ± 0.30 at switch follow-up and improved slightly to 0.53 ± 0.71 at final follow-up, AG (p = 0.46). In the RG, mean BCVA worsened from 0.57 ± 0.28 at baseline to 0.64 ± 0.31 at switch follow-up and improved slightly to 0.60 ± 0.36 at final follow-up, RG (p = 0.64).

CONCLUSION

Switching from bevacizumab to either aflibercept, or ranibizumab, has a strong anatomical effect in eyes with neovascular AMD. Nevertheless, even if the switch to aflibercept shows a minimal functional benefit over that to ranibizumab, visual prognosis remains limited.

Authors+Show Affiliations

Department of Ophthalmology, University of Basel, Mittlere Strasse 91, CH-4031, Basel, Switzerland. maria.waizel@usb.ch. Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach/Saar, Germany. maria.waizel@usb.ch.Department of Ophthalmology, University of Basel, Mittlere Strasse 91, CH-4031, Basel, Switzerland.Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach/Saar, Germany.Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach/Saar, Germany.Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach/Saar, Germany.Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach/Saar, Germany. University Eye Clinic Tuebingen, Centre for Ophthalmology, Tuebingen, Germany.University Eye Clinic Tuebingen, Centre for Ophthalmology, Tuebingen, Germany.Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, Sulzbach/Saar, Germany. University Eye Clinic Tuebingen, Centre for Ophthalmology, Tuebingen, Germany.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

28535756

Citation

Waizel, Maria, et al. "Switch to Aflibercept or Ranibizumab After Initial Treatment With Bevacizumab in Eyes With Neovascular AMD." BMC Ophthalmology, vol. 17, no. 1, 2017, p. 79.
Waizel M, Todorova MG, Masyk M, et al. Switch to aflibercept or ranibizumab after initial treatment with bevacizumab in eyes with neovascular AMD. BMC Ophthalmol. 2017;17(1):79.
Waizel, M., Todorova, M. G., Masyk, M., Wolf, K., Rickmann, A., Helaiwa, K., ... Szurman, P. (2017). Switch to aflibercept or ranibizumab after initial treatment with bevacizumab in eyes with neovascular AMD. BMC Ophthalmology, 17(1), p. 79. doi:10.1186/s12886-017-0471-x.
Waizel M, et al. Switch to Aflibercept or Ranibizumab After Initial Treatment With Bevacizumab in Eyes With Neovascular AMD. BMC Ophthalmol. 2017 May 23;17(1):79. PubMed PMID: 28535756.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Switch to aflibercept or ranibizumab after initial treatment with bevacizumab in eyes with neovascular AMD. AU - Waizel,Maria, AU - Todorova,Margarita G, AU - Masyk,Michael, AU - Wolf,Katharina, AU - Rickmann,Annekatrin, AU - Helaiwa,Khaled, AU - Blanke,Björn R, AU - Szurman,Peter, Y1 - 2017/05/23/ PY - 2017/02/14/received PY - 2017/05/15/accepted PY - 2017/5/25/entrez PY - 2017/5/26/pubmed PY - 2017/10/5/medline KW - Aflibercept KW - Bevacizumab KW - Ranibizumab KW - VEGF switch KW - Vascular endothelial growth factor KW - Vascular endothelial growth factor a SP - 79 EP - 79 JF - BMC ophthalmology JO - BMC Ophthalmol VL - 17 IS - 1 N2 - BACKGROUND: To evaluate changes in central macular thickness (CMT) and visual outcome in patients with neovascular age-related macular degeneration (AMD) treated initially with bevacizumab and subsequently switched to either aflibercept or ranibizumab. METHODS: Observational clinical study was performed. We measured the structural outcome (CMT on SD-OCT; μm) and the visual outcome (best corrected visual acuity (BCVA); logMAR), as follows: before treatment (at baseline), following bevacizumab treatment (switch follow-up) and after switching from bevacizumab to aflibercept- or ranibizumab treatment (final follow-up, AG/, RG). RESULTS: From a total of 96 eyes treated with intravitreal injections of bevacizumab (10.5 ± 7.6 (mean ± SD)), 58 eyes switched to aflibercept (6.5 ± 3.9; AG) and 38 eyes switched to ranibizumab (7.1 ± 5.3; RG) (≥ 3 injections, each). In addition, these eyes were compared to 37 eyes under bevacizumab monotherapy. PRIMARY OUTCOME: In the AG, the CMT decreased slightly from 430 ± 220 μm at baseline to 419 ± 212 μm at switch follow-up (p = 0.86), but decreased significantly to 318 ± 159 μm at final follow-up, AG (p < 0.0001). In the ranibizumab group (RG), the CMT increased from 396 ± 174 μm at baseline to 499 ± 333 μm at switch follow-up (p = 0.012), but decreased significantly to 394 ± 202 μm at final follow-up, RG (p = 0.007). Secondary outcome: In the AG, the mean BCVA worsened from logMAR 0.57 ± 0.33 at baseline to 0.63 ± 0.30 at switch follow-up and improved slightly to 0.53 ± 0.71 at final follow-up, AG (p = 0.46). In the RG, mean BCVA worsened from 0.57 ± 0.28 at baseline to 0.64 ± 0.31 at switch follow-up and improved slightly to 0.60 ± 0.36 at final follow-up, RG (p = 0.64). CONCLUSION: Switching from bevacizumab to either aflibercept, or ranibizumab, has a strong anatomical effect in eyes with neovascular AMD. Nevertheless, even if the switch to aflibercept shows a minimal functional benefit over that to ranibizumab, visual prognosis remains limited. SN - 1471-2415 UR - https://www.unboundmedicine.com/medline/citation/28535756/Switch_to_aflibercept_or_ranibizumab_after_initial_treatment_with_bevacizumab_in_eyes_with_neovascular_AMD_ L2 - https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-017-0471-x DB - PRIME DP - Unbound Medicine ER -