• Differential Response to Anti-VEGF Regimens in AMD Patients With Persistent Fluid

    By Marianne Doran and edited by Susan M. MacDonald, MD

    Journal Highlights

    Ophthalmology, September 2016

    Jaffe et al.
    compared the effects of in­travitreal aflibercept and ranibizumab on visual acuity outcomes in eyes with neovascular age-related macular degen­eration (NVAMD) and early persistent retinal fluid after 3 initial monthly in­jections. A regimen of aflibercept 2 mg every 4 weeks appeared to be the most beneficial in these eyes.

    The study was a post hoc analysis of 1,815 eyes from VIEW 1 and VIEW 2, which were 2 similarly designed randomized phase 3 trials. Patients included in the present study had a known fluid sta­tus (i.e., presence or absence; and, if present, cystic intraretinal or subretinal fluid) at baseline and at weeks 4, 8, and 12.

    All patients had received 3 initial monthly in­jections (loading dose), followed by 1 of 3 treatment regimens: ranibi­zumab 0.5 mg every 4 weeks (Rq4, n = 595); aflibercept 2 mg every 4 weeks (2q4, n = 613); or aflibercept 2 mg every 8 weeks (2q8, n = 607).

    The main outcome measures were mean best-corrected visual acuity (BCVA) change from baseline over weeks 16 to 52 and the proportion of eyes that gained ≥15 letters or lost ≥5 letters. The investigators evaluated eyes with and without persistent fluid at all 4 initial visits. Further, in eyes with persistent fluid, visual outcomes were compared between those with intrareti­nal vs. subretinal fluid.

    The proportion of eyes with per­sistent fluid after the initial 3 injections was 29.4%, 18.8%, and 20.3% in the Rq4, 2q4, and 2q8 groups, respectively.

    Among these eyes, mean BCVA gain from baseline to week 52 was greater in the 2q4 group compared with the Rq4 (p < .01) and 2q8 (p < .05) groups. At week 52, similar proportions of eyes had gained ≥15 letters (31.5%-35.2%), whereas fewer eyes lost ≥5 letters with 2q4 treatment compared with Rq4 and 2q8 (6.5% vs. 16.6% and 16.2%, respec­tively). In eyes with persistent fluid, the pattern of visual outcomes was similar regardless of the fluid type.

    However, in eyes that did not have early persistent fluid, the Rq4, 2q4, and 2q8 regimens all had a similar effect on BCVA.

    The authors stated that, to their knowledge, this report is the first to evaluate the proportion of eyes with early persistent fluid after a 3-injection loading dose and the effect of this fluid on visual outcome. Although noting that the study was limited by its retrospective post hoc analysis, they concluded that a regimen of 2q4 may provide additional clinical benefit over 2q8 or Rq4 in patients with early persistent fluid.

    The original article can be found here.