title: Fixed bimonthly aflibercept in naïve and switched neovascular age-related macular degeneration patients: one year outcomes.
abstract: OBJECTIVE
  To determine real life clinical outcomes in poorly responsive and treatment-naïve neovascular age related macular degeneration (nvAMD) patients using bimonthly fixed dosing aflibercept regimen.
  
  
  METHODS
  This was a retrospective study of 165 eyes with nvAMD started on aflibercept at Southampton Eye Unit between June 2013 and June 2014. Patients were either switched from pro re nata (PRN) ranibizumab/bevacizumab due to poor response (107 eyes), or treatment-naïve (58 eyes). Patients initially received 3-monthly intravitreal aflibercept injections followed by 2-monthly fixed doses. Clinic visits were scheduled at month 0, 4, 10 and 12. Mean change in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) from baseline were assessed using the Wilcoxon signed-rank test. The proportion of patients maintaining BCVA (<15 letters loss) at 12mo was also evaluated.
  
  
  RESULTS
  Mean BCVA change at month 12 was +3.29 and +4.67 letters in the switched and naïve aflibercept groups respectively (P<0.01). BCVA was maintained in 95.3% of switched and 96.6% of naïve patients. CRT at month 12 showed a decrease of -6.16 µm in the switched group and -35.36 µm in the naïve group (P<0.01). Patients previously treated with ranibizumab/bevacizumab had on average received 7.4 ranibizumab/bevacizumab injections over 12.6mo, attending 10 clinic visits. The fixed dosing aflibercept regimen required an average of 7.1 injections (naïve group), 7.5 injections (switched group) and 4 clinic visits per year.
  
  
  CONCLUSIONS
  Fixed bimonthly aflibercept is effective in both treatment-naïve and poorly responsive nvAMD patients. Adopting a fixed dosing regimen can reduce patient burden without compromising on outcomes.
authors: Clinical Neurosciences Research Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK.; Southampton Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK.
authors: Alasdair N
authors: AN
authors: Warwick
authors: Clinical Neurosciences Research Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK.
authors: Hannah H
authors: HH
authors: Leaver
authors: Clinical Neurosciences Research Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK.; Southampton Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK.
authors: Andrew J
authors: AJ
authors: Lotery
authors: Clinical Neurosciences Research Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK.; Southampton Eye Unit, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK.
authors: Srini V
authors: SV
authors: Goverdhan
keywords: aflibercept; age-related macular degeneration; anti-vascular endothelial growth factor; ranibizumab