Transitioning to intravitreal aflibercept following a previous treat-and-extend dosing regimen in neovascular age-related macular degeneration: 24-month results

Purpose: To evaluate frequency of injections, visual and anatomical outcomes of neovascular age-related macular degeneration (nAMD) patients transitioned to intravitreal aflibercept after failure to extend treatment interval beyond 8 weeks with prior intravitreal bevacizumab or ranibizumab. Methods: Retrospective review of patients with nAMD switched to aflibercept following >= 6 prior intravitreal ranibizumab or bevacizumab injections at 4-8-week intervals. Three monthly aflibercept injections were given followed by a treat-and-extend dosing regimen. Results: Twenty-one eyes of 18 patients who had received a mean of 23.8 +/- 18.8 (mean +/- SD; range 6-62) prior ranibizumab or bevacizumab injections were included. Over a mean follow-up of 24 months after the transition, 9.2 +/- 2.9 (range 4-21) aflibercept injections were required. Interval between aflibercept injections increased to 57.3 days (range 35-133 days), as compared with 37 +/- 6.1 days (range 29-54 days) with the prior agents (P = 0.01). Mean best-corrected visual acuity was preserved (0.42 +/- 0.31 vs 0.42 +/- 0.23 logMAR; P = 0.2). Mean OCT central subfoveal thickness (292.1 +/- 83.2 mu m to 283.6 +/- 78.6 mu m; P = 0.4) and mean macular volume (7.9 +/- 0.95 mm(3) to 7.67 +/- 0.94 mm(3); P = 0.16) remained stable. Conclusion: Patients requiring treatment more frequently than every 8 weeks with ranibizumab and bevacizumab were transitioned to 48-week treatment interval with aflibercept while maintaining the anatomic and visual gains.