This is a retrospective study of patients with neovascular age-related macular degeneration (AMD) treated with intravitreal Lucentis and / or Avastin who were switched to aflibercept (Eylea). This study was carried out by the Casey Eye Institute retinal clinics, between May and September 2012. The inclusion criteria for the subjects are: [1] they had received at least 12 months of prior anti-VEGF therapy with either Avastin or Lucentis (for cases that had received one year anti-VEGF therapy prior to conversion with a ‘base-line study visit’ defined as the visit nearest to 12 months prior to conversion and an allowable range of 10-14 months prior to conversion); [2] visual acuity at conversion was ≥20/400 when switching to Eylea; [3] they completed 12 months (final ‘study visit’ defined as the visit nearest to 12 months following conversion and an allowable range 10-14 months) of Eylea injections without switching therapies. The outcomes in this study included:
- The primary outcome was the mean number of injections in the year following the conversion to Eylea.
- Secondary outcome include a change in the central macular thickness at six months and one year, presence of intraretinal (IRF) and subretinal fluid (SRF) at six months and a visual acuity at one year.
One hundred and nine patients were included in this study and the overall frequency of Eylea injections was unchanged with patients receiving 7.4 anti-VEGF injections a year prior to conversion compared with 7.2 Eylea injections in the year following (p=0.47). The change to Eylea was associated with improvement in central macular thickness from 324 to 295µ (p=0.0001 at six months) and 299µ (p=0.0047 at one year). There was no effect on the visual acuity at one year. In a particular sub-group analysis, patients who had received ≥10 anti-VEGF injections in the year prior had fewer injections (11.1 to 8.4, p=0.0001) and clinic visits (13.9 to 9.6, p<0.0001), as well as significant decrease in central macular thickness (CMT) (-35µ, p=0.02). The authors conclude that from the study group, switching to Eylea was not associated with any change in injection frequency or any improvement of the visual acuity. However, there is associated improvement in the CMT at six months and one year. For those sub-group analysis patients who have received at least 10 anti-VEGF injections in the year prior, transitioning to Eylea was associated with a reduction in injection frequency and also CMT, therefore suggesting that there is a potential cost saving in this particular sub-group of population of patients. The authors suggest that longer term research is needed with a prospective randomised trial with strict retreatment guidelines, and a monotherapy control would ideally answer some of the questions raised in this study.
