title: INTRAVITREAL AFLIBERCEPT IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION WITH LIMITED RESPONSE TO RANIBIZUMAB: A Treat-and-Extend Trial.
abstract: OBJECTIVE
  To evaluate aflibercept treat-and-extend regimen for treatment of neovascular age-related macular degeneration in patients with limited response to ranibizumab.
  
  
  METHODS
  This prospective single-arm trial included 33 patients with neovascular age-related macular degeneration pretreated with treat-and-extend regimen ranibizumab for ≥6 months who failed to be extended to a 6-week interval at least twice. All patients received aflibercept (2 mg/0.05 mL) at baseline, and were subsequently treated according to treat-and-extend regimen, starting with a 4-week interval and extending in 2-week steps. Evaluations included mean maximum recurrence-free treatment interval; best-corrected visual acuity; central retinal thickness; and pigment epithelium detachment height and horizontal diameter.
  
  
  RESULTS
  At Week 24, the maximum recurrence-free treatment interval increased to ≥6 weeks in ∼35% of patients, whereas the mean interval was 4.9 ± 1.3 weeks. Best-corrected visual acuity score remained stable, but significant reductions in central retinal thickness (P < 0.001) and pigment epithelium detachment height (P = 0.001) were observed compared with baseline, as was a small decrease in horizontal pigment epithelium detachment diameter (P = 0.035).
  
  
  CONCLUSIONS
  After switching patients with limited ranibizumab response to aflibercept, signs of choroidal neovascularization activity regressed, and an increased duration of treatment effects was seen in approximately one-third of lesions, but visual acuity was unchanged.
authors.affiliation: *Department of Ophthalmology, Vista Klinik, Binningen, Switzerland; †University of Basel, Basel, Switzerland; and ‡Department of Ophthalmology, Kantonsspital Baselland, Eye Clinic, Liestal, Switzerland.
authors.forename: Katja
authors.initials: K
authors.lastname: Hatz
authors.forename: Christian
authors.initials: C
authors.lastname: Prünte
mesh_terms: D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D004361:Drug Tolerance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D011446:Prospective Studies; D000069579:Ranibizumab / Q000008:administration & dosage*; D040262:Receptors, Vascular Endothelial Growth Factor / Q000008:administration & dosage* / Q000037:antagonists & inhibitors; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage*; D055213:Retinal Pigment Epithelium / Q000473:pathology; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D020533:Angiogenesis Inhibitors; D011993:Recombinant Fusion Proteins; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab