Progress and Outcome of Therapeutic Switch to Aflibercept in Patients with Age-Related Macular Degeneration (AMD) Resistant to Bevacizumab

Objective: The purpose of the study is to evaluate the effect of Aflibercept in patients with age-related macular degeneration who had received prior treatment with Bevacizumab.

Material & Methods: An observational retrospective study was conducted in “Oftalmos, Centro Oftalmológico de Alta Complejidad”. We reviewed the clinical records of 41 eyes that had received at least three (3) intravitreal injections of Bevacizumab (1.25 mg) with a period no longer than 4 weeks between each application, prior switch to Aflibercept (2 mg). Of the selected patients, 27 had a diagnosis of choroidal neovascular membrane (CNVM), 5 had CNVM associated with neuroepithelium detachment and the remaining 9 eyes only had retinal pigment epithelium detachment (RPED). Rotation of anti-VEGF was due to the persistence or increase in central macular thickness observed in spectral domain optical coherence tomography (OCT). All patients received a loading dose of three intravitreal 2 mg Aflibercept injections at 4-week intervals. Evaluation included central macular thickness and maximum pigment epithelium (PED) height measured by spectral domain OCT and best-corrected visual acuity (BCVA) prior to the switch of therapy and 4 weeks after the last Aflibercept injection.

Results: A significant decrease in central macular thickness in spectral domain OCT (= or > 50 μm) was observed in 18 eyes (43.9%). In 17 eyes (41.46%) no changes in thickness were observed after the switch. In the remaining 6 eyes (14.63%) increased thickness was appreciated. There was an improvement in best-corrected visual acuity (= or>4 letters) in 22 patients (53.65%) while 15 (36.5%) maintained the same BCVA and the remaining 4 (9.75%) lost one line.

Discussion: Recent publications suggest that the use of Aflibercept in patients with AMD that do not have satisfactory response to treatment with Bevacizumab, could present better results. Despitethis, they have not yet obtained scientifically significant results. However, it is important to emphasize that both drugs have different mechanisms of action.

Conclusion: Although the number of patients, who had improved with the switch to Aflibercept, is not statistically significant, the rotation of antiangiogenic is a valid option in the absence of response.