title: Recovery of plasma vascular endothelial growth factor concentrations during aflibercept loading phase and after the transition to bimonthly treatment for neovascular age-related macular degeneration.
abstract: OBJECTIVE
  To provide data on plasma vascular endothelial growth factor (VEGF) concentration during three consecutive monthly intravitreal aflibercept injections and after transition to bimonthly treatment in patients with neovascular age-related macular degeneration (nAMD).
  
  
  METHODS
  Sixteen consecutive treatment-naïve Caucasian patients with nAMD were included in the study. The treatment consisted of one intravitreal aflibercept (2 mg) injection every 28 days for three consecutive months followed by a fourth injection 8 weeks later. VEGF plasma concentrations were measured with Luminex on day 0 (baseline, prior to first injection); days 1, 6 and 27 (prior to second injection); day 55 (prior to third injection) and days 97 and 111 (after third injection).
  
  
  RESULTS
  Baseline plasma VEGF concentration was 59.6±13.3 pg/mL. Aflibercept decreased plasma VEGF concentration to 32.5±3 pg/mL on day 1 (p<0.0001) and 34.7±6.3 pg/mL on day 6 (p<0.0001). On day 27, the VEGF plasma level increased to 50.6±6.5 pg/mL (p=0.009) and on day 55 to 52.8±8.8 pg/mL (p=0.027). There was no statistically significant difference between mean plasma VEGF concentrations on days 27 and 55 (p=0.139). Plasma VEGF concentration recovered completely 6 weeks after the third injection, reaching 57.9±9.6 pg/mL on day 97 (p=0.600) and 59.5±11.6 pg/mL on day 111 (p=0.987).
  
  
  CONCLUSIONS
  Intravitreal aflibercept decreases plasma VEGF concentration mostly in the first week after treatment. Despite repeated monthly intravitreal injections, there was a monthly increase in plasma VEGF values to near baseline levels, with complete recovery 6 weeks after the third injection.
  
  
  BACKGROUND
  Identifier no. NCT02125864.
authors.affiliation: Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.
authors.forename: Anca B
authors.initials: AB
authors.lastname: Roald
authors.affiliation: Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.
authors.forename: Hans C D
authors.initials: HC
authors.lastname: Aass
authors.affiliation: Department of Ophthalmology, Oslo University Hospital, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Morten C
authors.initials: MC
authors.lastname: Moe
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D040262:Receptors, Vascular Endothelial Growth Factor / Q000008:administration & dosage* / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage* / Q000627:therapeutic use; D012160:Retina / Q000473:pathology; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000097:blood*; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000097:blood / 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
keywords: Degeneration; Macula; Neovascularisation; Retina; Treatment Medical