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    Long-term aflibercept effective for nAMD after other anti-VEGF therapies failed

    San Diego––Aflibercept injections were beneficial for patients who were previously treated with other anti-vascular endothelial growth factor (VEGF) drugs and who showed persistent or recurrent fluid resulting from their neovascular age-related macular degeneration (nAMD). 

    Although the patients’ anatomic findings improved, the visual acuity (VA) remained the same during the 2-year, follow-up period in most patients, according to Ilkay Kilic Muftuoglu, MD. Dr. Muftuoglu is a visiting assistant professor at the University of California, San Diego.

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    In this retrospective, single-center, interventional, consecutive case series, all patients had been treated with intraretinal injections of bevacizumab (Avastin) or ranibizumab (Lucentis, both from Genentech) and were administered by the same retina specialist, reported Dr. Muftuoglu, the lead author of the study. 

    Patients had persistent intraretinal or subretinal fluid for 5 months or more–or had multiple recurrences of fluid­–after being completely dry at multiple visits during follow-up. They then were treated every 8 weeks with an as-needed regimen of aflibercept (Eylea, Regeneron Pharmaceuticals) injections until the complete resolution of intraretinal and/or subretinal fluid.

     

    Injections escalated

    If the fluid persisted despite this treatment for 5 months, the regimen was escalated to every 4 weeks of as-needed aflibercept injections. No loading dose of the drug was administered due to the partial treatment with anti-VEGF agents other than aflibercept, Dr. Muftuoglu said.

    All patients underwent spectral-domain optical coherence tomography (SD-OCT) imaging during the follow-up. At each visit, the investigators evaluated the anatomic outcomes that included the maximal retinal thickness, central macular thickness, maximal height of pigment epithelial detachments, maximal height of the retinal fluid, and visual acuity (VA).

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    A total of 81 eyes of 78 patients were included in the study, and the numbers of patients with recurrent or persistent fluid were similar. The patients had received a mean of 14 injections of an anti-VEGF drug other than aflibercept. The patients were followed for 24 months and received a mean of 11 injections of the drug during the course of the study, Dr. Muftuoglu said.

    “After 3 consecutive bimonthly injections, patients showed significant improvement in all anatomic outcomes and this improvement was maintained during the 2-year follow-up,” Dr. Muftuoglu added.

    The investigators reported their findings in the American Journal of Ophthalmology (2016;167:1-9).

    Completely dry retina

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