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Results of switchback from ranibizumab to aflibercept in patients with exudative age-related macular degeneration

Authors Koike N, Otsuji T, Tsumura A, Miki K, Sakai Y, Nishimura T, Takahashi K

Received 27 February 2019

Accepted for publication 27 June 2019

Published 15 July 2019 Volume 2019:13 Pages 1247—1251


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Naoko Koike,1 Tsuyoshi Otsuji,1 Akiko Tsumura,1 Katsuaki Miki,1 Yukio Sakai,1 Tetsuya Nishimura,1 Kanji Takahashi2

1Department of Ophthalmology, Kansai Medical University Medical Center, Osaka, Japan; 2Department of Ophthalmology, Kansai Medical University, Osaka, Japan

Purpose: Intravitreal injection of anti-VEGF drugs has become standard therapy for patients with exudative age-related macular degeneration (AMD). However, some patients do not exhibit sufficient response to the drugs for suppression of choroidal neovascularization activity. We investigated the efficacy of switchback from ranibizumab to aflibercept in patients with AMD who could not achieve further benefit beyond initial therapy of aflibercept injection.
Methods: Eleven eyes of eleven patients were included in this study. Two patients were nonresponders, and nine exhibited tachyphylaxis to aflibercept. All patients received three monthly injections of ranibizumab as an initial phase of switching and received aflibercept as a switchback drug. We investigated changes in injection interval, visual acuity, and central retinal thickness.
Results: In four patients (36.4%), injection interval was extended. The interval was 6.73 weeks before switch and 9.27 weeks after switchback (P=0.96). LogMAR visual acuity was 0.22 before switch and 0.24 after switchback (P=0.62). Central retinal thickness was 306.8 μm before switch and 256.1 after switchback (P=0.13). In all patients who were nonresponders to aflibercept, injection interval could not be extended.
Conclusion: A switchback from ranibizumab to aflibercept may be beneficial in some patients with AMD who exhibit tachyphylaxis to aflibercept.

Keywords: AMD, aflibercept, ranibizumab, switchback, anti-VEGF drugs

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