Higher Dose Anti-VEGF Therapy May Improve Treatment-Resistant Neovascular AMD

A study comparing higher dose intravitreal bevacizumab, ranibizumab, and aflibercept for treatment-resistant neovascular age-related macular degeneration (AMD) detected no differences in efficacy or safety between the antivascular endothelial growth factor (anti-VEGF) agents. Researchers published their findings in Graefe’s Archive for Clinical and Experimental Ophthalmology.

“Higher dose therapy may achieve improved anatomic outcomes and maintain vision, but frequent injections are required to achieve this,” reported researchers from the National Eye Institute, National Institutes of Health, Bethesda, MD.

Researchers reached the conclusion after a retrospective analysis of 37 eyes of 35 patients with treatment-resistant neovascular AMD who were subsequently treated with higher dose intravitreal bevacizumab, ranibizumab, or aflibercept. The eyes were analyzed at standard time points for up to 48 months. The average follow-up was 22.8 months.

“There was no significant difference in visual acuity or intraocular pressure change compared to the initiation of high-dose treatment for any agent or comparing between agents at any time point,” researchers wrote.

With all three agents, central retinal thickness improved at months 1, 3, 6, and 12. The reduction in central retinal thickness was greater with ranibizumab than aflibercept at month 6—but central retinal thickness was also greater in the ranibizumab group at baseline, according to the study. For all agents, average absolute central retinal thickness was similar at month 6.

Intravitreal injection rates before and after conversion to higher-dose therapy were also similar, with an injection occurring every 5.7 to 6.4 weeks, the study showed.

Reference:
Broadhead GK, Keenan TDL, Chew EY, Wiley HE, Cukras CA. Comparison of agents using higher dose anti-VEGF therapy for treatment-resistant neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol. Published online January 29, 2022. doi:10.1007/s00417-021-05547-9