title: One-year outcomes of aflibercept in recurrent or persistent neovascular age-related macular degeneration.
abstract: OBJECTIVE
  To evaluate 6-month and 1-year outcomes of every-8-weeks (Q8W) aflibercept in patients with resistant neovascular age-related macular degeneration (AMD).
  
  
  METHODS
  Retrospective, interventional, consecutive case series.
  
  
  METHODS
  Retrospective review of patients with resistance (multiple recurrences or persistent exudation) to every-4-weeks (Q4W) ranibizumab or bevacizumab that were switched to Q8W aflibercept.
  
  
  RESULTS
  Sixty-three eyes of 58 patients had a median of 13 (interquartile range [IQR], 7-22) previous anti-vascular endothelial growth factor (anti-VEGF) injections. At 6 months after changing to aflibercept, 60.3% of eyes were completely dry, which was maintained up to 1 year. The median maximum retinal thickness improved from 355 μm to 269 μm at 6 months (P < .0001) and 248 μm at 1 year (P < .0001). There was no significant improvement in ETDRS visual acuity at 6 months (P = .2559) and 1 year follow-up (P = .1081) compared with baseline. The mean difference in ETDRS visual acuity compared to baseline at 6 months was -0.05 logMAR (+2.5 letters) and 0.04 logMAR at 1 year (-2 letters).
  
  
  CONCLUSIONS
  Sixty percent of eyes with resistant AMD while on Q4W ranibizumab or bevacizumab were completely dry after changing to Q8W aflibercept at the 6-month and 1-year follow-ups, but visual acuity did not significantly improve. Only a third of eyes needed to be switched from Q8W to Q4W aflibercept owing to persistence of fluid; Q8W dosing of aflibercept without the initial 3 monthly loading doses may be a good alternative in a select group of patients who may have developed ranibizumab or bevacizumab resistance.
authors.affiliation: Jacobs Retina Center, University of California San Diego Shiley Eye Center, La Jolla, California.
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Arcinue
authors.affiliation: Jacobs Retina Center, University of California San Diego Shiley Eye Center, La Jolla, California.
authors.forename: Feiyan
authors.initials: F
authors.lastname: Ma
authors.affiliation: Jacobs Retina Center, University of California San Diego Shiley Eye Center, La Jolla, California.
authors.forename: Giulio
authors.initials: G
authors.lastname: Barteselli
authors.affiliation: University of California San Diego Shiley Eye Center, La Jolla, California.
authors.forename: Lucie
authors.initials: L
authors.lastname: Sharpsten
authors.affiliation: Jacobs Retina Center, University of California San Diego Shiley Eye Center, La Jolla, California.
authors.forename: Maria Laura
authors.initials: ML
authors.lastname: Gomez
authors.affiliation: Jacobs Retina Center, University of California San Diego Shiley Eye Center, La Jolla, California. Electronic address: wrfreeman@ucsd.edu.
authors.forename: William R
authors.initials: WR
authors.lastname: Freeman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000068258:Bevacizumab; D004351:Drug Resistance; D057915:Drug Substitution; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D000069579:Ranibizumab; D040262:Receptors, Vascular Endothelial Growth Factor / Q000627:therapeutic use*; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D058471:Subretinal Fluid; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity / Q000187:drug effects / Q000502:physiology; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy* / 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