Early Response to Ranibizumab Is Predictive of Treatment Demand after a Therapeutic Switch to Aflibercept.

Objective: In many case series, anatomical but not functional improvements have been documented after a switch in therapy from ranibizumab to aflibercept. We wished to compare the outcomes of eyes that had undergone a switch in therapy from ranibizumab to aflibercept because of a high treatment demand or for other reasons.
Design: Retrospective comparative case series.
Participants: Patients (≥50 years of age) undergoing treatment for neovascular age-related macular degeneration in a routine clinical setting.
Methods: Eyes monitored for ≥10 months after switch in intravitreal therapy from ranibizumab to aflibercept were allocated to one of 2 groups: eyes with high treatment demand because of insufficient response to ranibizumab (persisting intraretinal fluid or injection frequency of ≤6 weeks [group 1, n = 34]) and eyes in which the switch had been instigated for other reasons (n = 94).
Main Outcome Measures: Annual number of injections before and after the switch in therapy.
Results: Patients were of comparable ages at the time of diagnosis. The follow-up time before switching, but not thereafter, was shorter in group 1 than in group 2 (P = 0.001). Visual acuity and central retinal thickness did not change appreciably during the follow-up period. The annual number of injections was higher under ranibizumab than under aflibercept in group 1 (9.1±2.2 injections vs. 5.7±2.2 injections; P = 0.0005) but not in group 2 (4.9±2.0 injections vs. 4.6±1.8 injections; P = 0.24). After the switch from ranibizumab to aflibercept, the eyes in group 1 required more injections than did those in group 2 (P = 0.007). The time that elapsed to a reinjection differed between the 2 groups under treatment with ranibizumab (P = 0.0005) as well as under that with aflibercept (P = 0.007).
Conclusion: After the switch in therapy from ranibizumab to aflibercept, visual acuity remained stable for >12 months in both groups. Nevertheless, eyes that required frequent reinjections under ranibizumab also had a higher treatment demand under aflibercept.
(Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)