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AFLIBERCEPT AFTER RANIBIZUMAB INTRAVITREAL INJECTIONS IN EXUDATIVE AGE–RELATED MACULAR DEGENERATION: The ARI2 Study

Blanco-Garavito, Rocio, MD*,†; Jung, Camille, PhD*,†,‡; Uzzan, Joel, MD§; Quaranta-ElMaftouhi, Maddalena, MD; Coscas, Florence, MD*; Sahel, Jose, PhD**; Korobelnik, Jean-Francois, MD††,‡‡; Béchet, Stéphane, PhD§§; Querques, Giuseppe, PhD*,†; Souied, Eric, H., PhD*,†

doi: 10.1097/IAE.0000000000001928
Original Study: PDF Only

Purpose: To analyze the efficacy of aflibercept switch treatment for regression of pigment epithelial detachment (PED) in patients previously treated with ranibizumab.

Methods: Multicenter, prospective, nonrandomized clinical trial. One eye of patients presenting neovascular age–related macular degeneration with PED of more than 250 μm in height, with persistent fluid, was included. Patients had to have received at least six ranibizumab intravitreal injections during the 12 months before enrollment. Patients were switched from ranibizumab pro re nata to aflibercept (fixed regimen, 3 monthly intravitreal injections, and then Q6). Main outcome measure was change in PED height from baseline to Week 12 after switch. Secondary outcomes were best-corrected visual acuity and PED volume changes.

Results: Eighty four patients were included. Mean delay between last ranibizumab intravitreal injection and switch was 44.7 days. Mean maximal PED height at baseline visit was 347 μm (±109) and reduced to a mean of 266 μm (±114) at Week 12 (P < 0.001) and 288.2 μm at Week 32 (P < 0.001). Mean PED volume was reduced from 1.3 mm3 to 0.98 mm3 at Week 12 (P < 0.001). Best-corrected visual acuity improved by 3.3 Early Treatment Diabetic Retinopathy Study letters at Week 32 (P = 0.003).

Conclusion: Aflibercept switch therapy seems to be effective on large PED in patients previously treated with pro re nata ranibizumab.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Treatment-resistant pigment epithelial detachments can be effectively treated with aflibercept switch therapy. Patients were treated with 3 monthly intravitreal injections and then a Q6 regimen. Mean pigment epithelial detachment height and volume were statistically reduced after the switch at primary endpoint (12 weeks), and best-corrected visual acuity also improved steadily throughout the duration of the study.

*Service Universitarie d'Ophtalmologie, Hopital Intercommunal de Créteil, Créteil, France;

Centre de Recherche Clinique Macula, Université Paris Est Créteil, Créteil, France;

Centre de Ressources Biologiques, Hopital Intercommunal de Créteil, Créteil, France;

§Clinique Mathilde, Rouen, France;

Clinique Rabelais, Lyon, France;

**Hôpital Quinze Vingts, Paris, France;

††Service d'ophtalmologie, CHU de Bordeaux, University Bordeaux, ISPED, Bordeaux, France;

‡‡Inserm, U1219—Bordeaux Population Health Research Center, Bordeaux, France; and

§§Association Clinique et Thérapeutique Infantile du Val de Marne, Saint Maur, France.

Reprint requests: Eric H. Souied, PhD, Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université Paris Est Créteil, 40 Avenue de Verdun, 94000 Créteil, France; e-mail: eric.souied@chicreteil.fr

This study was performed through a research grant from the sponsor Bayer (Loos, France). The sponsor had no role in the design and conduct of the study, nor in the writing of this report or in the decision to submit this research.

None of the authors has any conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.