Effect of Medication Change on Eyes With Macular Edema Due to Retinal Vein Occlusion
JAMA Ophthalmology, March 2019
What happens when patients who respond poorly to one anti-VEGF medication are switched to another? In evaluating patients with macular edema, Ip et al. found that patients with an inadequate response to bevacizumab may benefit from a switch to aflibercept, but the small sample and lack of control group do not allow for definitive conclusions.
This secondary analysis of SCORE2 data was performed at 66 centers in the United States (private practice or academic). Participants were required to have edema caused by central retinal vein occlusion (CRVO) or hemiretinal vein occlusion (HRVO). Outcomes of interest were changes in visual acuity and central subfield thickness (CST) from month 6 (treatment switch) to month 12 for eyes that responded poorly to aflibercept or bevacizumab in SCORE2. Eyes that had received aflibercept monthly were switched to treatment with a dexamethasone implant at month 6 and, if needed, at months 9, 10, or 11. Eyes treated initially with bevacizumab were switched to aflibercept at months 6, 7, and 8, followed by a treat-and-extend regimen of aflibercept until month 12.
Forty-nine patients (49 eyes) were included in the study; aflibercept failed in 14, and bevacizumab failed in 35. Among the 14 eyes that were switched from aflibercept to dexamethasone, the mean change from months 6 to 12 in visual acuity letter score (VALS) was 2.63 (p = .37), and the mean change in CST was 46.0 μm (p = .46). For the 35 eyes that were switched from bevacizumab to aflibercept, the mean changes from months 6 to 12 were 10.27 in VALS (p < .001) and −125.4 μm in CST (p < .001).
This research suggests that eyes with CRVO or HRVO that do not respond well to bevacizumab may benefit from a switch to aflibercept. The authors recommended caution when interpreting the study findings, particularly because so few eyes had a poor initial response to aflibercept. The small sample and the lack of controls, randomization, and masking preclude determining whether a switching strategy is superior, similar, or inferior to continuing the original treatment.
The original article can be found here.