title: Aflibercept in exudative age related macular degeneration refractory to ranibizumab.
abstract: OBJECTIVE
  The aim of this study is to determine the effectiveness, safety and cost of aflibercept in the treatment of wet age-related macular degeneration (ARMD) refractory to ranibizumab.
  
  
  METHODS
  Retrospective observational study was conducted on patients diagnosed with wet ARMD, and previously treated with ranibizumab. Efficacy variables assessed were changes in visual acuity (BCVA) and anatomical improvements in the most affected eye. Factors associated with improvement of BCVA with aflibercept were also studied. Adverse events related to the aflibercept administration were recorded. Cost analysis data were collected from the hospital perspective, and only taking the direct medical costs into account. Cost-effectiveness analysis was calculated using the aflibercept treatment cost, and effectiveness calculated as BCVA gained.
  
  
  RESULTS
  A total of 50 eyes corresponding to 46 patients were included. The median follow-up period was 4.6 months (range: 1.0-6.0). Improvement in visual acuity after the first 2 doses and at the end of the follow-up period was observed in 32.0 and 28.0% of treated eyes, respectively. None of the variables studied was associated with an improvement in the BCVA after treatment. No significant differences were found in the average monthly cost between treatments.
  
  
  CONCLUSIONS
  Aflibercept is shown to be an effective treatment in a significant number of patients resistant to treatment with ranibizumab, presenting a cost similar to that generated during the final stages of treatment with ranibizumab.
authors.affiliation: Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, España. Electronic address: jrzrms@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Ruiz Ramos
authors.affiliation: Servicio de Oftalmología, Hospital Universitario y Politécnico La Fe, Valencia, España.
authors.forename: I
authors.initials: I
authors.lastname: Pascual-Camps
authors.affiliation: Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, España.
authors.forename: M J
authors.initials: MJ
authors.lastname: Cuéllar-Monreal
authors.affiliation: Servicio de Oftalmología, Hospital Universitario y Politécnico La Fe, Valencia, España.
authors.forename: R
authors.initials: R
authors.lastname: Dolz-Marco
authors.affiliation: Servicio de Oftalmología, Hospital Universitario y Politécnico La Fe, Valencia, España.
authors.forename: M A
authors.initials: MA
authors.lastname: Fenoll
authors.affiliation: Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, España.
authors.forename: I
authors.initials: I
authors.lastname: Font-Noguera
authors.affiliation: Servicio de Farmacia, Hospital Universitario y Politécnico La Fe, Valencia, España.
authors.forename: J L
authors.initials: JL
authors.lastname: Poveda-Andrés
authors.affiliation: Servicio de Oftalmología, Hospital Universitario y Politécnico La Fe, Valencia, España.
authors.forename: R
authors.initials: R
authors.lastname: Gallego-Pinazo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003941:Diagnostic Techniques, Ophthalmological / Q000191:economics; D016527:Drug Costs; D057915:Drug Substitution; D005260:Female; D005500:Follow-Up Studies; D005102:Health Expenditures; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D000069579:Ranibizumab / Q000191:economics / Q000627:therapeutic use*; D040262:Receptors, Vascular Endothelial Growth Factor / Q000627:therapeutic use*; D011993:Recombinant Fusion Proteins / Q000191:economics / Q000627:therapeutic use*; D012189:Retrospective Studies; D014792:Visual Acuity; D057135:Wet Macular Degeneration / Q000188:drug therapy* / Q000191:economics
chemical_list: D020533:Angiogenesis Inhibitors; D011993:Recombinant Fusion Proteins; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab
keywords: Aflibercept; Agudeza visual; Cost-effectiveness; Coste-efectividad; Degeneración macular; Macular degeneration; Ranibizumab; Visual acuity