Switching to aflibercept may be beneficial in AMD cases with persistent fluid

This restrospective review found significant anatomic improvement after a single aflibercept injection, with gains maintained at six months in AMD cases with persistent fluid despite previous regular treatment with ranibizumab and/or bevacizumab.

The authors write that there are several possible explanations for the observed anatomic benefit after switching to aflibercept, including its pharmacodynamics and the possibility of tachyphylaxis to prior treatment with ranibizumab/bevacizumab.

They reviewed the charts of wet AMD cases with persistent fluid treated regularly with ranibizumab 0.5 mg and/or bevacizumab 1.25 mg that were switched to intravitreal aflibercept 2.0 mg and followed for six months. Of 353 cases, 28 patients had persistent fluid after an average of 20 regular ranibizumab/bevacizumab injections (range, 7 to 37).

One month after a single aflibercept injection, 89 percent of eyes showed anatomic improvement and 18 percent were dry. Central subfoveal thickness improved from 295 to 272 microns (P < 0.001) After an average of 4.4 aflibercept injections (range, 3 to 6) over six months, central subfoveal thickness remained improved, 64 percent of eyes showed anatomic improvement and 25 percent of eyes were dry.

Interestingly, there was no improvement in visual acuity, which raises the issue of whether a completely dry macula is needed for the best visual acuity results. Further prospective studies are needed to address these issues.