title: Neovascular age-related macular degeneration treated with ranibizumab or aflibercept in the same large clinical setting: visual outcome and number of injections.
abstract: OBJECTIVE
  To study visual outcome and number of annual injections in treatment-naïve patients with neovascular age-related macular degeneration (nAMD) before and after a change in first-line therapy from ranibizumab to aflibercept in a high-volume clinical practice.
  
  
  METHODS
  This was a retrospective chart review of routine clinical practice. The study included 1027 treatment-naïve patients, 559 of whom started intravitreal ranibizumab therapy in 2011-2012 and 468 of whom started intravitreal aflibercept therapy in 2013-2014, a fixed loading dose of three injections followed by a pro re nata treatment regimen used in both periods.
  
  
  RESULTS
  Snellen best-corrected visual acuity (BCVA) at baseline and after one year was 0.23 and 0.31 (p < 0.0001), respectively, for patients treated with ranibizumab and 0.25 and 0.33 (p < 0.0001) for patients treated with aflibercept, last observation carried forward. The share of patients (73%) still in treatment with ranibizumab at year 1 had a baseline BCVA of 0.26 but 0.40 at year 1 (p < 0.0001), and the patients (75%) still in treatment with aflibercept at year 1 had a baseline BCVA of 0.28 but 0.42 at year 1 (p < 0.0001). Proportional visual gains for both cohorts were comparable for one year (p = 0.14). The number of injections given within year 1 including first injection was 6.9 for ranibizumab and 5.9 for aflibercept (p < 0.0001). In patients continuing treatment through year 1, the number of injections was 8.0 for ranibizumab and 6.6 for aflibercept (p < 0.0001). The two cohorts had similar cause-of-discontinuation profiles.
  
  
  CONCLUSIONS
  Treatment of nAMD at a single centre in two sequential cohorts yielded comparable BCVA outcomes with 15% fewer injections of aflibercept compared to ranibizumab.
authors.affiliation: Department of Ophthalmology, Rigshospitalet-Glostrup, Glostrup, Denmark.|University of Copenhagen, Copenhagen, Denmark.
authors.forename: Annette
authors.initials: A
authors.lastname: Rasmussen
authors.affiliation: Department of Ophthalmology, Rigshospitalet-Glostrup, Glostrup, Denmark.|University of Copenhagen, Copenhagen, Denmark.
authors.forename: Birgit
authors.initials: B
authors.lastname: Sander
authors.affiliation: Department of Ophthalmology, Rigshospitalet-Glostrup, Glostrup, Denmark.|University of Copenhagen, Copenhagen, Denmark.
authors.forename: Michael
authors.initials: M
authors.lastname: Larsen
authors.affiliation: Department of Ophthalmology, Rigshospitalet-Glostrup, Glostrup, Denmark.
authors.forename: Sara
authors.initials: S
authors.lastname: Brandi
authors.affiliation: Department of Ophthalmology, Rigshospitalet-Glostrup, Glostrup, Denmark.|University of Copenhagen, Copenhagen, Denmark.
authors.forename: Josefine
authors.initials: J
authors.lastname: Fuchs
authors.affiliation: Department of Ophthalmology, Rigshospitalet-Glostrup, Glostrup, Denmark.|University of Copenhagen, Copenhagen, Denmark.
authors.forename: Louise H
authors.initials: LH
authors.lastname: Hansen
authors.affiliation: Department of Ophthalmology, Rigshospitalet-Glostrup, Glostrup, Denmark.|University of Copenhagen, Copenhagen, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Lund-Andersen
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D020256:Choroidal Neovascularization / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D000069579:Ranibizumab / Q000008:administration & dosage*; D040262:Receptors, Vascular Endothelial Growth Factor / Q000008:administration & dosage*; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D011993:Recombinant Fusion Proteins; D042461:Vascular Endothelial Growth Factor A; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab
keywords: aflibercept; clinical practice; neovascular age-related macular degeneration; ranibizumab; visual acuity