title: [Change of therapy from ranibizumab to aflibercept for recurrent or persistent exudative age-related macular degeneration].
abstract: BACKGROUND
  Even during consistent anti-vascular endothelial growth factor (VEGF) therapy a reactivation of exudative age-related macular degeneration (AMD) lesions can be observed in many patients. The present case series examined whether a switch from ranibizumab to aflibercept is safe and whether differences in potency can be observed.
  
  
  METHODS
  In 56 consecutive patients with recurrent activity of AMD according to the morphological criteria of the spectral domain optical coherence tomography (SD-OCT) examination, a change to aflibercept was made after 6-41 (mean 18.9, SD 6.3) injections with ranibizumab. In all controls and before each injection logMAR visual acuity was measured and a SD-OCT (volume scan) was performed in addition to the clinical examination.
  
  
  RESULTS
  The mean visual acuity was stable under both therapies. The analysis of the morphological parameters showed a greater reduction of the retinal thickness after the change in therapy (mean retinal thickness within 1000 μm and central foveal thickness) compared to the initial treatment. The changes in the subretinal fluid as well as the height of an associated pigment epithelial detachment (PED) did not show any significant differences. The analysis of the morphological parameters at the level of the photoreceptors showed a decrease in discontinuity in the ellipsoid layer and also in the external limiting membrane (ELM).
  
  
  CONCLUSIONS
  In patients with recurrent or high SD-OCT-based activity of exudative AMD lesions, a switch of the treatment strategy from ranibizumab to aflibercept can achieve a new functional stability in spite of multiple pretreatment. We found morphological indications of a regression of intraretinal edema and improvement in the photoreceptor area. In the context of a well-defined treatment strategy, a switch from anti-VEGF therapy to a similar active substance is safe. Before a definitive evaluation can be made, prospective controlled conditions are required to verify the clinical benefits of the switch.
authors.affiliation: Augenabteilung am St. Franziskus Hospital, Hohenzollernring 74, 48145, Münster, Deutschland, Martin.Ziegler@makula-centrum-muenster.de.
authors.forename: M
authors.initials: M
authors.lastname: Ziegler
authors.forename: B
authors.initials: B
authors.lastname: Heimes
authors.forename: B
authors.initials: B
authors.lastname: Book
authors.forename: M
authors.initials: M
authors.lastname: Dietzel
authors.forename: M
authors.initials: M
authors.lastname: Zeimer
authors.forename: G
authors.initials: G
authors.lastname: Spital
authors.forename: M
authors.initials: M
authors.lastname: Gutfleisch
authors.forename: D
authors.initials: D
authors.lastname: Pauleikhoff
authors.forename: A
authors.initials: A
authors.lastname: Lommatzsch
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D002908:Chronic Disease; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D000069579:Ranibizumab / Q000008:administration & dosage*; D040262:Receptors, Vascular Endothelial Growth Factor / Q000008:administration & dosage*; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage*; D012008:Recurrence; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D014792:Visual Acuity; D057135:Wet Macular Degeneration / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*
chemical_list: D020533:Angiogenesis Inhibitors; D011993:Recombinant Fusion Proteins; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab