Fixed bimonthly aflibercept in naïve and switched neovascular age related macular degeneration patients: 1 year outcomes

Aim: To determine real life clinical outcomes in poorly responsive and treatment-naïve neovascular age related macular degeneration (nvAMD) patients using bi-monthly fixed dosing aflibercept regimen.Methods: This was a retrospective study of 165 eyes with nvAMD started on aflibercept at Southampton Eye Unit between June 2013 and June 2014. Patients were either switched from pro re nata (PRN) ranibizumab/bevacizumab due to poor response (107 eyes), or treatment-naïve (58 eyes). Patients received 3 initial monthly intravitreal aflibercept injections followed by 2-monthly fixed doses. Clinic visits were scheduled at months 0, 4, 10 and 12. Mean change in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) from baseline were assessed using the Wilcoxon signed-rank test. The proportion of patients maintaining BCVA (<15 letters loss) at 12 months was also evaluated.Results: Mean BCVA change at month 12 was +3.29 and +4.67 letters in the switched and naïve aflibercept groups respectively (p<0.01). BCVA was maintained in 95.3% of switched and 96.6% of naïve patients. CRT at month 12 showed a decrease of -6.16µm in the switched group and -35.36µm decrease in the naïve group (p<0.01). Patients previously treated with ranibizumab/bevacizumab had on average received 7.4 ranibizumab/bevacizumab injections over 12.6 months, attending 10 clinic visits. The fixed dosing aflibercept regimen required an average of 7.13 injections (naïve group), 7.5 injections (switched group) and 4 clinic visits per year.Conclusion: Fixed bimonthly aflibercept is effective in both treatment-naïve and poorly responsive nvAMD patients. Adopting a fixed dosing regimen can reduce patient burden without compromising on outcomes