This is a six-month, prospective, single-arm study in the UK and Germany. A total of 100 patients were enrolled (one in the primary failure group, 99 in the suboptimal treatment response group), treated three-monthly intravitreal ranibizumab injections (0.5mg), and then pro re nata at monthly visits. The primary endpoint was change from baseline (CFB) to day 90 in central subfield retinal thickness (CSRT). A significant CFB was found in median CSRT of -30.75um (p,0.0001) to day 90. Maximum pigment epithelial detachment (PED) and intraretinal cyst (IRC) height, intraretinal fluid and subretinal fluid in qualitative optical coherence tomography (OCT) parameters were also reduced. In the EDTRS letters assessed by the groups, 55% and 59% of patients gained 0->15 letters versus baseline, at day 90 and day 180, respectively. Mean improvements in best corrected visual acuity (BCVA) (CFB) to each time point were small (up to two letters). The authors concluded that the SAFARI study showed switching to ranibizumab following an inadequate response or loss of efficacy whilst aflibercept led to a significant improvement in the primary efficacy end point of CSRT with approximately 60% achieving stabilised or improved VA. Patients with neovascular age-related macular degeneration (nARMD) who have shown suboptimal response to aflibercept may benefit from switching to ranibizumab.
Anatomical and functional outcomes following switching from aflibercept to ranibizumab in NARMD
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