Systemic levels of vascular endothelial growth factor before and after intravitreal injection of aflibercept or ranibizumab in patients with age-related macular degeneration: a randomised, prospective trial

PurposeTo evaluate the changes of vascular endothelial growth factor (VEGF) plasma levels after intravitreal injections of aflibercept or ranibizumab in patients with exudative age-related macular degeneration (AMD). MethodsThirty-eight patients with exudative AMD were included in this randomised, prospective study. Nineteen patients were randomised to treatment with intravitreal aflibercept (2.0mg) and 19 to intravitreal ranibizumab (0.5mg). The concentration of VEGF was measured by ELISA just before the injection, after 7days and 1month. Twenty-two age- and sex-matched healthy patients without chorioretinal diseases served as control. ResultsThe median baseline plasma VEGF concentration was 61.0pg/ml in the control group, 43.0pg/ml in the aflibercept group and 59.0pg/ml in the ranibizumab group (p=0.127). Seven days after intravitreal injection of aflibercept plasma levels were significantly reduced to values below the minimum detectable dose (MDD) in 17 of 19 patients (89.5%) resulting in a median VEGF concentration of <9pg/ml (p<0.001). The reduction persisted throughout 1month with values below the MDD in 5 of 19 patients (26.3%) and a median measurement of 17.0pg/ml (p<0.001). In patients treated with ranibizumab no significant effects could be observed with a baseline VEGF of 59.0pg/ml, 54.0pg/ml at 7days (p=0.776) and 58.5pg/ml at 4weeks of follow-up (p=0.670). ConclusionAfter intravitreal aflibercept injection, the systemic VEGF levels were significantly reduced throughout the observational period of 4weeks. No significant systemic effects of intravitreal ranibizumab on plasma VEGF were observed.