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Aflibercept more effectively weans patients with neovascular age-related macular degeneration off therapy compared with bevacizumab

BACKGROUND: Studies assessing the efficacy of therapies for neovascular age-related macular degeneration (nvAMD) have demonstrated that aflibercept may have a longer treatment interval than its less-expensive alternative, bevacizumab. However, whether this benefit justifies the additional cost of af...

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Autores principales: Cao, Xuan, Sanchez, Jaron Castillo, Patel, Tapan P., Yang, Zhiyong, Guo, Chuanyu, Malik, Danyal, Sopeyin, Anuoluwapo, Montaner, Silvia, Sodhi, Akrit
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Society for Clinical Investigation 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9843049/
https://www.ncbi.nlm.nih.gov/pubmed/36413411
http://dx.doi.org/10.1172/JCI159125
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author Cao, Xuan
Sanchez, Jaron Castillo
Patel, Tapan P.
Yang, Zhiyong
Guo, Chuanyu
Malik, Danyal
Sopeyin, Anuoluwapo
Montaner, Silvia
Sodhi, Akrit
author_facet Cao, Xuan
Sanchez, Jaron Castillo
Patel, Tapan P.
Yang, Zhiyong
Guo, Chuanyu
Malik, Danyal
Sopeyin, Anuoluwapo
Montaner, Silvia
Sodhi, Akrit
author_sort Cao, Xuan
collection PubMed
description BACKGROUND: Studies assessing the efficacy of therapies for neovascular age-related macular degeneration (nvAMD) have demonstrated that aflibercept may have a longer treatment interval than its less-expensive alternative, bevacizumab. However, whether this benefit justifies the additional cost of aflibercept remains under debate. We have recently reported that a treat-and-extend-pause/monitor approach can be used to successfully wean 31% of patients with nvAMD off anti-VEGF therapy. Here, we examined whether the choice of therapy influences the outcomes of this approach. METHODS: In this retrospective analysis, 122 eyes of 106 patients with nvAMD underwent 3 consecutive monthly injections with either aflibercept (n = 70) or bevacizumab (n = 52), followed by a treat-and-extend protocol, in which the decision to extend the interval between treatments was based on visual acuity, clinical exam, and the presence or absence of fluid on optical coherence tomography. Eyes that remained stable 12 weeks from their prior treatment were given a 6-week trial of holding further treatment, followed by quarterly monitoring. Treatment was resumed for worsening vision, clinical exam, or optical coherence tomography findings. RESULTS: At the end of 1 year, eyes receiving bevacizumab had similar vision but required more injections (8.7 ± 0.3 treatments vs. 7.2 ± 0.3 treatments) compared with eyes receiving aflibercept. However, eyes treated with aflibercept were almost 3 times more likely to be weaned off treatment (43% vs. 15%) compared with eyes treated with bevacizumab at the end of 1 year. CONCLUSION: These observations expose an advantage of aflibercept over bevacizumab and have important clinical implications for the selection of therapy for patients with nvAMD. FUNDING: This work was supported by the National Eye Institute, NIH grants R01EY029750 and R01EY025705, Research to Prevent Blindness, the Alcon Young Investigator Award from the Alcon Research Institute, and the Branna and Irving Sisenwein Professorship in Ophthalmology.
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spelling pubmed-98430492023-01-20 Aflibercept more effectively weans patients with neovascular age-related macular degeneration off therapy compared with bevacizumab Cao, Xuan Sanchez, Jaron Castillo Patel, Tapan P. Yang, Zhiyong Guo, Chuanyu Malik, Danyal Sopeyin, Anuoluwapo Montaner, Silvia Sodhi, Akrit J Clin Invest Clinical Medicine BACKGROUND: Studies assessing the efficacy of therapies for neovascular age-related macular degeneration (nvAMD) have demonstrated that aflibercept may have a longer treatment interval than its less-expensive alternative, bevacizumab. However, whether this benefit justifies the additional cost of aflibercept remains under debate. We have recently reported that a treat-and-extend-pause/monitor approach can be used to successfully wean 31% of patients with nvAMD off anti-VEGF therapy. Here, we examined whether the choice of therapy influences the outcomes of this approach. METHODS: In this retrospective analysis, 122 eyes of 106 patients with nvAMD underwent 3 consecutive monthly injections with either aflibercept (n = 70) or bevacizumab (n = 52), followed by a treat-and-extend protocol, in which the decision to extend the interval between treatments was based on visual acuity, clinical exam, and the presence or absence of fluid on optical coherence tomography. Eyes that remained stable 12 weeks from their prior treatment were given a 6-week trial of holding further treatment, followed by quarterly monitoring. Treatment was resumed for worsening vision, clinical exam, or optical coherence tomography findings. RESULTS: At the end of 1 year, eyes receiving bevacizumab had similar vision but required more injections (8.7 ± 0.3 treatments vs. 7.2 ± 0.3 treatments) compared with eyes receiving aflibercept. However, eyes treated with aflibercept were almost 3 times more likely to be weaned off treatment (43% vs. 15%) compared with eyes treated with bevacizumab at the end of 1 year. CONCLUSION: These observations expose an advantage of aflibercept over bevacizumab and have important clinical implications for the selection of therapy for patients with nvAMD. FUNDING: This work was supported by the National Eye Institute, NIH grants R01EY029750 and R01EY025705, Research to Prevent Blindness, the Alcon Young Investigator Award from the Alcon Research Institute, and the Branna and Irving Sisenwein Professorship in Ophthalmology. American Society for Clinical Investigation 2023-01-17 /pmc/articles/PMC9843049/ /pubmed/36413411 http://dx.doi.org/10.1172/JCI159125 Text en © 2023 Cao et al. https://creativecommons.org/licenses/by/4.0/This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Clinical Medicine
Cao, Xuan
Sanchez, Jaron Castillo
Patel, Tapan P.
Yang, Zhiyong
Guo, Chuanyu
Malik, Danyal
Sopeyin, Anuoluwapo
Montaner, Silvia
Sodhi, Akrit
Aflibercept more effectively weans patients with neovascular age-related macular degeneration off therapy compared with bevacizumab
title Aflibercept more effectively weans patients with neovascular age-related macular degeneration off therapy compared with bevacizumab
title_full Aflibercept more effectively weans patients with neovascular age-related macular degeneration off therapy compared with bevacizumab
title_fullStr Aflibercept more effectively weans patients with neovascular age-related macular degeneration off therapy compared with bevacizumab
title_full_unstemmed Aflibercept more effectively weans patients with neovascular age-related macular degeneration off therapy compared with bevacizumab
title_short Aflibercept more effectively weans patients with neovascular age-related macular degeneration off therapy compared with bevacizumab
title_sort aflibercept more effectively weans patients with neovascular age-related macular degeneration off therapy compared with bevacizumab
topic Clinical Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9843049/
https://www.ncbi.nlm.nih.gov/pubmed/36413411
http://dx.doi.org/10.1172/JCI159125
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