title: [Switching Therapy from Ranibizumab and/or Bevacizumab to Aflibercept in Neovascular Age-Related Macular Degeneration (AMD): One-Year Results].
abstract: BACKGROUND
  The presented study is a retrospective evaluation of switching therapy from ranibizumab and/or bevacizumab to aflibercept in neovascular age-related macular degeneration in patients who had previously given an insufficient response to therapy with ranibizumab and/or bevacizumab.
  
  
  METHODS
  96 eyes with neovascular age-related macular degeneration (AMD) were included, which had been pretreated with ranibizumab and/or bevacizumab (T&E), but had responded insufficiently. An injection interval of less than six weeks or permanently persisting intra- and/or subretinal fluid or persistent pigment epithelial detachments (PED) were defined as an insufficient response. The patients were followed for 12 months after switching therapy to aflibercept. The change in central retinal thickness (CRT) was defined as the primary endpoint. Other endpoints were the axial height of PEDs and the injection interval.
  
  
  RESULTS
  The primary endpoint, the average CRT, was significantly decreased twelve months after switching therapy to aflibercept (Wilcoxon Nemenyi-McDonald-Thompson post-hoc analysis - 31.36 µm; SD ± 70.64 µm; p < 0.001). Another morphological endpoint, the average axial height of PEDs, also decreased significantly (- 34.10 µm; SD ± 91.90 µm, p < 0.001) from 207.82 µm (SD ± 148.12 µm) at baseline to 173.72 µm (SD ± 132.30 µm) at month 12. Moreover, the average injection interval increased significantly (p < 0.001; Friedman test) from 1.30 months (SD ± 0.19 months) before switching therapy to 1.67 months (SD ± 0.19 months) at month 12 after switching therapy to aflibercept. However, the best corrected visual acuity (BCVA) as a functional endpoint did not significantly improve (+ 0.36 ETDRS letters = 0.0972 p; SD ± 16.94 ETDRS letters).
  
  
  CONCLUSIONS
  In patients with neovascular AMD, who had initially exhibited an inadequate response to ranibizumab and/or bevacizumab, switching therapy to aflibercept improves clinical outcome measures. Besides morphological improvements, such as the decrease of the CRT and the axial height of PEDs, the average injection interval was prolonged. However, visual acuity did not improve.
authors.affiliation: Augenklinik, Universitätsklinikum Bonn.
authors.forename: M
authors.initials: M
authors.lastname: Pfau
authors.affiliation: Augenklinik, Stadtspital Triemli, Zürich, Schweiz.
authors.forename: H M
authors.initials: HM
authors.lastname: Fassnacht-Riederle
authors.affiliation: Augenklinik, Stadtspital Triemli, Zürich, Schweiz.
authors.forename: F J
authors.initials: FJ
authors.lastname: Freiberg
authors.affiliation: Augenklinik, Stadtspital Triemli, Zürich, Schweiz.
authors.forename: J B
authors.initials: JB
authors.lastname: Wons
authors.affiliation: Augenklinik, Stadtspital Triemli, Zürich, Schweiz.
authors.forename: M
authors.initials: M
authors.lastname: Wirth
authors.affiliation: Augenklinik, Stadtspital Triemli, Zürich, Schweiz.
authors.forename: M D
authors.initials: MD
authors.lastname: Becker
authors.affiliation: Augenklinik, Stadtspital Triemli, Zürich, Schweiz.
authors.forename: S
authors.initials: S
authors.lastname: Michels
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D000068258:Bevacizumab / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D057915:Drug Substitution / Q000379:methods / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D000069579:Ranibizumab / Q000008:administration & dosage*; D040262:Receptors, Vascular Endothelial Growth Factor / Q000008:administration & dosage*; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage*; D012189:Retrospective Studies; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome; D014792:Visual Acuity / Q000187:drug effects*; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*
chemical_list: D020533:Angiogenesis Inhibitors; D011993:Recombinant Fusion Proteins; C533178:aflibercept; D000068258:Bevacizumab; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab