EFFECT OF RANIBIZUMAB AND AFLIBERCEPT ON RETINAL PIGMENT EPITHELIAL DETACHEMENT, SUBRETINAL AND INTRARETINAL FLUID IN AGE-RELATED MACULAR DEGENERATION
Authors:
P. Sumarová 1,2; P. Ovesná 3; V. Matušková 1,2; J. Beránek 1,2; M. Michalec 1,2; L. Michalcová 1; D. Autrata 1,2; D. Vysloužilová 1,2; O. Chrapek 1,2
Authors‘ workplace:
Oční klinika FN Brno
1; Oční klinika, Lékařská fakulta, Masarykova univerzita Brno
2; Institut biostatistiky a analýz s. r. o., Brno
3
Published in:
Čes. a slov. Oftal., 78, 2022, No. 4, p. 176-185
Category:
Original Article
doi:
https://doi.org/10.31348/2022/20
Overview
Purpose: The aim of the study was to compare the effect of three initial doses of the anti-VEGF ranibizumab and aflibercept medication on serous pigment epithelial detachment (PED), subretinal fluid (SRF) and intraretinal fluid (IRF) in the macula of treatment naive neovascular AMD (nvAMD) patients.
Material and Methods: The cohort consists of 148 patients, of which 74 patients were treated with ranibizumab (51 females and 23 males) and 74 with aflibercept (46 females and 28 males). The data was recorded prospectively from the moment of diagnosis and start of treatment for a period of 3 months. At the moment of diagnosis and 3 months later, an OCT examination (Spectralis OCT, Heidelberg Engineering, Heidelberg, Germany) was performed. The OCT examination included a macular scan with 25 scans. Using the OCT instrument software, we measured the maximum anterior-posterior elevation of serous PED, the highest thickness of SRF and the largest diameter of the intraretinal cystic space. The statistical significance of differences between groups was evaluated using the t-test for continuous data and the Fisher exact test for categorical data. Changes in values of continuous variables over time were evaluated using the Wilcoxon paired test. Paired comparisons of binary parameters were determined by the McNemar test.
Results: Full regression of PED, SRF and IRF occurred in 3 (4.1%), 25 (39%) and 20 (51%) patients treated with ranibizumab, and in 5 (7.9%, p = 0.470), 28 (47%, p = 0.470) and 25 (57%, p = 0.827) patients treated with aflibercept, respectively. The average regression of PED, SRF and IRF was -60.4 μm (median -37.5 μm), -84.3 μm (median -85 μm) and -109.3 μm (median -81 μm) in patients treated with ranibizumab, and -46.3 μm (median -30 μm, p = 0.389), -127.7 μm (median -104 μm, p = 0.096) and -204.4 μm (median -163 μm, p = 0.005) in patients treated with aflibercept, respectively. We did not show a statistically significant difference in the regression rates of PED, SRF and IRF between the ranibizumab and aflibercept groups. (in patients with IRF after adjustment of the higher baseline IRF volumes in patients treated with aflibercept, p = 0.891).
Conclusion: We are convinced that ranibizumab and aflibercept have the same effect on serous PED, SRF and IRF in the macula in patients with treatment naive nvAMD during the initial loading phase.
Keywords:
ranibizumab – aflibercept – age-related macular degeneration – pigment epithelium detachment – subretinal fluid – intraretinal fluid
Sources
1. Bressler NM, Bressler SB, Fine SL. Age related macular degeneration. Surv Ophthalmol. 1988;32(6):375-413.
2. Simader Ch, Ritter M, Bolz M, et al. Morphologic Parameters Relevant for Visual Outcome during Anti-Angiogenic Therapy of Neovascular Age-Related Macular Degeneration. Ophthalmology 2014;121(6):1237-1245.
3. Schmidt-Erfurth U, Waldstein SM, Deak GG, Kundi M., Simader Ch. Pigment Epithelial Detachment Followed by Retinal Cystoid Degeneration Leads to Vision Loss in Treatment of Neovascular Age-Related Macular Degeneration. Ophthalmology 2015;122(4):822- 832.
4. Rosenfeld PJ, Brown DM, Heier JS, et al. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med. 2006;355(14):1419-1431.
5. Brown DM, Kaiser PK, Michels M, et al. Ranibizumab versus verteporfin for neovascular age-related macular degeneration. N Engl J Med. 2006;355:1432-1444.
6. Brown DM, Michels M, Kaiser PK, Heier JS, Sy JP, Ianchulev T. Ranibizumab versus verteporfin photodynamic therapy for neovascular age-related macular degeneration: two-year results of the ANCHOR study. Ophthalmology 2009;116(1):57-65.
7. Heier JS, Brown DM, Chong V, et al. Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration. Ophthalmology 2012;119(12): 2537-2548.
8. Schmidt-Erfurth U, Kaiser PK, Korobelnik JF, et al. Intravitreal Aflibercept Injection for Neovascular Age-related Macular Degeneration: ninety-six-week results of the VIEW studies. Ophthalmology 2014;121(1):193-201.
9. Papadopoulos N, Martin J, Ruan Q, et al. Binding and neutralization of vascular endothelial growth factor (VEGF) and related ligands by VEGF Trap, ranibizumab and bevacizumab. Angiogenesis 2012;15(2):171-185.
10. Gillies MC, Hunyor AP, Arnold JJ, et al. Effect of Ranibizumab and Aflibercept on Best-Corrected Visual Acuity in Treat-and-Extend for Neovascular Age-Related Macular Degeneration: A Randomized Clinical Trial. JAMA Opthalmol 2019;137(4):372-379.
11. Silva R, Berta A, Larsen M, et al. Treat-and-Extend versus Monthly Regimen in Neovascular Age-Related Macular Degeneration: Results with Ranibizumab from the TREND Study. Ophthalmology 2018;125(1):57-65.
12. Busbee BG, Ho AC, Brown DM, Heier JS, Suner IJ, Li Z. Twelve- -month efficacy and safety of 0.5 mg or 2.0 mg ranibizumab in patients with subfoveal neovascular age-related macular degeneration. Ophthalmology 2013;120(5):1046-1056.
13. Clemens CR, Wolf A, Alten F, Milojcic C, Heiduschka P, Eter N. Response of vascular pigment epithelium detachment due to age-related macular degeneration to monthly treatment with ranibizumab: the prospective, multicentre RECOVER study. Acta Ophthalmol. 2017;95(7):683-689.
14. Němčanský J, Stepanov A, Koubek M, Veith M, Klimesova JM, Studnicka J. Response to Aflibercept Therapy in Three Types of Choroidal Neovascular Membrane in Neovascular Age-Related Macular Degeneration: Real-Life Evidence in the Czech Republic. Journal of Ophthalmol, 2019;Article ID 2635689.
15. Ashraf M, Souka A, Adelman R. Age-related macular degeneration: using morphological predictors to modify current treatment protocols. Acta Ophthalmol. 2018;96(2):120-133.
16. Waldstein SM, Simader C, Staurenghi G, et al. Morphology and visual acuity in aflibercept and ranibizumab therapy for neovascular age-related macular degeneration in the VIEW trials. Ophthalmology 2016;123(7):1521-1529.
17. Waldstein SM, Wright J, Warburton J, Margaron P, Simader Ch, Schmidt-Erfurth U. Predictive value of retinal morphology for visual acuity outcomes of different ranibizumab treatment regimens for neovascular AMD. Ophthalmology 2016;123(1):60-69.
18. Dirani A, Ambresin A, Marchionno L, Decugis D, Mantel I. Factors influencing the treatment response of pigment epithelium detachment in age-related macular degeneration. Am J Ophthalmol. 2015;160(4):732-738.
19. de Massougnes S, Dirani A, Mantel I. Good visual outcome at 1 year in neovascular age-related macular degeneration with pigment epithelium detachment. Factors influencing the treatment response. Retina 2017;0:1-8.
20. Cho HJ, Kim KM, Kim HS, Lee DW, Kim CG, Kim JW. Response of pigment epithelial detachment to anti-vascular endothelial growth factor treatment in age-related macular degeneration. Am J Ophthalmol. 2016;166:112-9.
21. Chakravarthy U, Harding SP, Rogers CA, Downes SM, Lotery AJ, Wordsworth S, et al. Ranibizumab versus bevacizumab to treat neovascular age-related macular degeneration: one-year findings from the IVAN randomized trial. Ophthalmology 2012;119(7):1399-1411.
21. Chakravarthy U, Harding SP, Rogers CA, et al. Ranibizumab versus bevacizumab to treat neovascular age-related macular degeneration: one-year findings from the IVAN randomized trial. Ophthalmology 2012;119(7):1399-1411.
22. Martin DF, Maguire MG, Fine SL, et al. Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results. Ophthalmology 2012;119(7):1388-1398.
Labels
OphthalmologyArticle was published in
Czech and Slovak Ophthalmology
2022 Issue 4
Most read in this issue
- VITAMIN D AND OPHTHALMOPATHIAS. A REVIEW
- EN BLOC RESECTION OF RETINAL VASOPROLIFERATIVE TUMOR USING 23G VITRECTOMY. A CASE REPORT
- EFFECT OF RANIBIZUMAB AND AFLIBERCEPT ON RETINAL PIGMENT EPITHELIAL DETACHEMENT, SUBRETINAL AND INTRARETINAL FLUID IN AGE-RELATED MACULAR DEGENERATION
- COINCIDENCE OF IDIOPATHIC INTRACRANIAL HYPERTENSION AND LEBER HEREDITARY OPTIC NEUROPATHY. A CASE REPORT