12-Month Outcomes of Ranibizumab vs. Aflibercept for Neovascular AMD
Ophthalmology, December 2016
Although the VIEW I and II randomized controlled studies compared ranibizumab and aflibercept for neovascular age-related macular degeneration (nAMD), Gillies et al. sought to compare the visual acuity (VA) outcomes between the 2 drugs as used in routine clinical practice. At 12 months, they found no significant difference in the VA outcomes nor in the number of injections between these anti-VEGF agents.
This was an observational database study of 394 treatment-naïve eyes with nAMD in the Fight Retinal Blindness outcome registry. Anti-VEGF therapy was started with ranibizumab (n = 197) or aflibercept (n = 197) between Dec. 1, 2013, and Jan. 31, 2015. Eyes were matched at baseline for VA, age, and choroidal neovascular membrane (CNV) size. The main outcome measures were change in mean VA, number of injections and visits, and proportion of eyes with inactive CNV over 12 months.
The mean (standard deviation) VA of ranibizumab-treated eyes increased from 58.6 (20.3) letters at baseline to 62.3 (23.9) for a gain of 3.7 letters, compared with 58.9 (19.2) letters at baseline to 63.1 (21.5) for a gain of 4.26 letters in aflibercept-treated eyes. The difference in change in the crude VA of 0.6 letters between the 2 groups was not statistically significant, nor was the difference in adjusted mean VA of the 2 groups. Among participants who completed the study, the mean numbers of injections (8.1 vs. 8.0; p = .27) and visits (9.6 vs. 9.5; p = .15) did not differ between the ranibizumab and aflibercept groups, respectively. Similarly, there was no significant difference in the proportion of eyes in which the CNV was graded as inactive (ranibizumab, 74%; aflibercept, 77%; p = .63).
The researchers concluded that both ranibizumab and aflibercept delivered similar, good outcomes after 12 months of treatment for nAMD in routine clinical practice and that there was no difference in treatment frequency between the 2 drugs. They acknowledged that the lack of prospective randomization is a weakness of this study but said that their data were likely to reflect real-world practice and outcomes.
The original article can be found here.