title: SWITCHING TREATMENT FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION FROM BEVACIZUMAB TO RANIBIZUMAB: Who is Likely to Benefit From the Switch?
abstract: OBJECTIVE
  To evaluate the safety and efficacy of switching from bevacizumab to ranibizumab in patients with neovascular age-related macular degeneration.
  
  
  METHODS
  Retrospective study of patients with neovascular age-related macular degeneration initially treated with bevacizumab and switched to ranibizumab. Visual acuity and central retinal thickness (CRT) were retrieved at four time points: before the last three bevacizumab injections, at the switch, after the first three ranibizumab injections, and at the end of follow-up.
  
  
  RESULTS
  One hundred and fourteen eyes of 110 patients were included. Switching from bevacizumab to ranibizumab did not achieve a significant change in visual acuity, and a significant reduction in CRT was achieved after the first three injections but was not maintained by the end of follow-up. Eyes that lost ≥0.1 logMAR before the switch were more likely to improve in visual acuity (P = 0.013), and eyes with ≥10% increase in CRT before the switch were more likely to improve anatomically (P = 0.0003). In 47.3% of the eyes, the CRT was reduced by ≥10% after the first 3 ranibizumab injections, and the reduction was maintained with additional injections.
  
  
  CONCLUSIONS
  Switching to ranibizumab should be considered in patients with visual acuity decrease or CRT increase, despite monthly bevacizumab injections. The response should be evaluated after the first three injections to guide future treatment.
authors.affiliation: *Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; †Department of Ophthalmology, Sheba Medical Center, Ramat Gan, Israel; the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; ‡Assuta Medical Centers, Tel Aviv, Israel; and §Maccabi Healthcare Services, Tel Aviv, Israel.
authors.forename: Elad
authors.initials: E
authors.lastname: Moisseiev
authors.forename: Gabriel
authors.initials: G
authors.lastname: Katz
authors.forename: Joseph
authors.initials: J
authors.lastname: Moisseiev
authors.forename: Anat
authors.initials: A
authors.lastname: Loewenstein
authors.forename: Michaella
authors.initials: M
authors.lastname: Goldstein
authors.forename: Yosef
authors.initials: Y
authors.lastname: Lomnicky
authors.forename: Yitzhak
authors.initials: Y
authors.lastname: Abend
authors.forename: Giora
authors.initials: G
authors.lastname: Treister
authors.forename: Dafna
authors.initials: D
authors.lastname: Goldenberg
authors.forename: Hana
authors.initials: H
authors.lastname: Levkovitch-Verbin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000627:therapeutic use*; D057915:Drug Substitution; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D000069579:Ranibizumab / Q000627:therapeutic use*; D012160:Retina / Q000473:pathology; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab