title: Injection frequency and anatomic outcomes 1 year following conversion to aflibercept in patients with neovascular age-related macular degeneration.
abstract: OBJECTIVE
  To evaluate the clinical, anatomic and functional effects of conversion to aflibercept following ranibizumab and/or bevacizumab in patients with neovascular age-related macular degeneration (AMD).
  
  
  METHODS
  A retrospective review of patients with neovascular AMD treated with intravitreal ranibizumab and/or bevacizumab who were switched to aflibercept was performed. The primary outcome was change in injection frequency in the year following the change. Secondary outcomes included change in central macular thickness (CMT) at 6 months and 1 year, presence of intraretinal and subretinal fluid at 6 months and visual acuity at 1 year.
  
  
  RESULTS
  A total of 109 eyes with neovascular AMD were switched to aflibercept and met inclusion criteria. Overall, aflibercept injection frequency was unchanged with patients receiving 7.4 antivascular endothelial growth factor (VEGF) injections the year prior to conversion compared with 7.2 aflibercept injections in the year following (p=0.47). However, the change to aflibercept was associated with improvement in CMT from 324 to 295 μm (p=0.0001) at 6 months and 299 μm (p=0.0047) at 1 year. There was no effect on visual acuity at 1 year. In a subgroup analysis, patients who had received ≥10 anti-VEGF injections in the year prior had fewer injections (11.1 to 8.4, p<0.0001) and clinic visits (13.9 to 9.6, p<0.0001) as well as a significant decrease in CMT (-35 μm, p=0.02).
  
  
  CONCLUSIONS
  In our population, switching to aflibercept therapy was not associated with a change in injection frequency nor improved visual acuity, but was associated with improved CMT at 6 months and 1 year. In patients who received at least 10 anti-VEGF injections in the year prior, transitioning to aflibercept was associated with a reduced injection frequency and CMT, suggesting potential cost savings in this population.
authors.affiliation: Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Wyatt B
authors.initials: WB
authors.lastname: Messenger
authors.affiliation: Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: J Peter
authors.initials: JP
authors.lastname: Campbell
authors.affiliation: Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA Duke Eye Center, Duke University, Durham, North Carolina, USA.
authors.forename: Ambar
authors.initials: A
authors.lastname: Faridi
authors.affiliation: Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Loton
authors.initials: L
authors.lastname: Shippey
authors.affiliation: Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Steven T
authors.initials: ST
authors.lastname: Bailey
authors.affiliation: Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Andreas K
authors.initials: AK
authors.lastname: Lauer
authors.affiliation: Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Christina J
authors.initials: CJ
authors.lastname: Flaxel
authors.affiliation: Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Hwang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000627:therapeutic use; D000068258:Bevacizumab; D004334:Drug Administration Schedule; D004341:Drug Evaluation / Q000379:methods; D057915:Drug Substitution; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008266:Macula Lutea / Q000473:pathology; D008297:Male; D008875:Middle Aged; D000069579:Ranibizumab; D040262:Receptors, Vascular Endothelial Growth Factor / Q000008:administration & dosage* / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage* / Q000627:therapeutic use; D012189:Retrospective Studies; D058471:Subretinal Fluid / Q000187:drug effects; D016896:Treatment Outcome; D014792:Visual Acuity / Q000187:drug effects; D057135:Wet Macular Degeneration / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D011993:Recombinant Fusion Proteins; C533178:aflibercept; D000068258:Bevacizumab; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab
keywords: Degeneration; Macula; Treatment Medical