PRN Ranibizumab verses continuous aflibercept in UK clinical practice
Reviewed by Jonathan Chan

This was a multicentre (21 UK hospitals), national EMR study on treatment naïve nAMD eyes, undergoing predominantly as needed (PRN) Ranibizumab or continuous (fixed or treat and extend - (F/TE)) Aflibercept (Af). The primary outcome was change in vision at one year. All eyes were age matched. Gender, starting visual acuity (VA) and year of starting treatment were recorded. A total of 1884 eyes were included (942 in each group). At one year, patients on PRN Ranibizumab (Rb) gained 1.6 EDTRS letters, while the Af group gained 6.1 letters. Change in VA at one year of the F/TE Af group was 4.1 letters higher compared with the PRN Rb group, after adjusting for age, starting VA, gender and year of starting treatment. The F/TE Af group had more injections compared the PRN Rb group (7 v 5.8, p<2.2e-16) but required less clinic visits than the PRN Rb group (10.8 v 9, p<2.2e-16). An incremental cost-effectiveness ratio of 58k GBP/quality-adjusted life year for continuous Af over PRN Rb treatment was calculated. The authors concluded that Af achieved greater VA gains at one year than Rb. The observed VA differences are small and likely due to the continuous frequent treatment of Af. The study suggested that Rb should also be delivered by F/TE regime.

UK AMD/DR EMR report IX: comparative effectiveness of predominantly as needed (PRN) ranibizumab verses continuous aflibercept in UK clinical practice.
Lee AY, Lee CS, Egan CA, et al.
BRITISH JOURNAL OF OPHTHALMOLOGY
2017;101:1683-8.