Switching to Aflibercept in Diabetic Macular Edema After Unsatisfactory Response to Other Anti-vascular Endothelial Growth Factor Drugs

Overview

Journal Korean J Ophthalmol

Specialty Ophthalmology

Date 2019 Apr 13

PMID 30977321

Citations 5

Authors

Walid S Ibrahim

Zeiad H Eldaly

Mohamed G Saleh

Mahmoud F Rateb

Ahmed H Aldoghaimy

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate the efficacy of switching to aflibercept in diabetic macular edema (DME) with suboptimal response to previous anti-vascular endothelial growth factor (anti-VEGF) injections.

Methods: A prospective interventional case series study recruited patients from a single center diagnosed with DME with suboptimal response to anti-VEGF injections. Three consecutive monthly injections of aflibercept were performed. The primary outcome measure was mean change in visual acuity after switching to aflibercept.

Results: Forty-two patients (42 eyes) were included. Baseline logarithm of the minimum angle of resolution (logMAR) visual acuity was 0.87 ± 0.23 and improved significantly to 0.62 ± 0.29, 0.56 ± 0.34, and 0.46 ± 0.35 at 1, 2, and 3 months, respectively, after the first injection. Mean baseline retinal thickness was 451.57 ± 107.09 μm and decreased significantly at 1, 2, and 3 months after switching to aflibercept (346.52 ± 79.03, 328.24 ± 81.98, and 313.71 ± 85.79 μm, respectively). Both visual improvement and mean change in retinal thickness were significant in patients with pre-aflibercept best-corrected visual acuity less than 1.0 logMAR but were not significant in patients with best-corrected visual acuity more than 1.0 logMAR.

Conclusions: Switching to aflibercept in DME patients with an unsatisfactory response to previous anti-VEGF injections provided acceptable short-term visual and retinal architectural improvement.

Citing Articles

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Modified early intensive and treat-and-extend regimen of anti-vascular endothelial growth factor for diabetic macular edema in Taiwan.

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Changes in metamorphopsia following intravitreal aflibercept injection for diabetic macular edema.

Murakami T, Okamoto F, Sugiura Y, Morikawa S, Okamoto Y, Hiraoka T Sci Rep. 2022; 12(1):17356.

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Efficacy of switching therapy to aflibercept for patients with persistent diabetic macular edema: a systematic review and meta-analysis.

Liu Y, Cheng J, Gao Y, Qin L, Min X, Zhang M Ann Transl Med. 2020; 8(6):382.

PMID: 32355826 PMC: 7186737. DOI: 10.21037/atm.2020.02.04.

References

Schaal S, Kaplan H, Tezel T . Is there tachyphylaxis to intravitreal anti-vascular endothelial growth factor pharmacotherapy in age-related macular degeneration?. Ophthalmology. 2008; 115(12):2199-205. DOI: 10.1016/j.ophtha.2008.07.007. View

Forooghian F, Chew E, Meyerle C, Cukras C, Wong W . Investigation of the role of neutralizing antibodies against bevacizumab as mediators of tachyphylaxis. Acta Ophthalmol. 2009; 89(2):e206-7. DOI: 10.1111/j.1755-3768.2009.01773.x. View

Praidou A, Androudi S, Brazitikos P, Karakiulakis G, Papakonstantinou E, Dimitrakos S . Angiogenic growth factors and their inhibitors in diabetic retinopathy. Curr Diabetes Rev. 2010; 6(5):304-12. DOI: 10.2174/157339910793360815. View

Binder S . Loss of reactivity in intravitreal anti-VEGF therapy: tachyphylaxis or tolerance?. Br J Ophthalmol. 2011; 96(1):1-2. DOI: 10.1136/bjophthalmol-2011-301236. View

Yau J, Rogers S, Kawasaki R, Lamoureux E, Kowalski J, Bek T . Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012; 35(3):556-64. PMC: 3322721. DOI: 10.2337/dc11-1909. View

Papadopoulos N, Martin J, Ruan Q, Rafique A, Rosconi M, Shi E . Binding and neutralization of vascular endothelial growth factor (VEGF) and related ligands by VEGF Trap, ranibizumab and bevacizumab. Angiogenesis. 2012; 15(2):171-85. PMC: 3338918. DOI: 10.1007/s10456-011-9249-6. View

Nguyen Q, Brown D, Marcus D, Boyer D, Patel S, Feiner L . Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology. 2012; 119(4):789-801. DOI: 10.1016/j.ophtha.2011.12.039. View

Stewart M, Rosenfeld P, Penha F, Wang F, Yehoshua Z, Bueno-Lopez E . Pharmacokinetic rationale for dosing every 2 weeks versus 4 weeks with intravitreal ranibizumab, bevacizumab, and aflibercept (vascular endothelial growth factor Trap-eye). Retina. 2012; 32(3):434-57. DOI: 10.1097/IAE.0B013E31822C290F. View

Rajendram R, Fraser-Bell S, Kaines A, Michaelides M, Hamilton R, Esposti S . A 2-year prospective randomized controlled trial of intravitreal bevacizumab or laser therapy (BOLT) in the management of diabetic macular edema: 24-month data: report 3. Arch Ophthalmol. 2012; 130(8):972-9. DOI: 10.1001/archophthalmol.2012.393. View

10.

Arjamaa O, Minn H . Resistance, not tachyphylaxis or tolerance. Br J Ophthalmol. 2012; 96(8):1153-4. DOI: 10.1136/bjophthalmol-2012-301823. View

11.

Do D, Nguyen Q, Boyer D, Schmidt-Erfurth U, Brown D, Vitti R . One-year outcomes of the da Vinci Study of VEGF Trap-Eye in eyes with diabetic macular edema. Ophthalmology. 2012; 119(8):1658-65. DOI: 10.1016/j.ophtha.2012.02.010. View

12.

Moradi A, Sepah Y, Sadiq M, Nasir H, Kherani S, Sophie R . Vascular endothelial growth factor trap-eye (Aflibercept) for the management of diabetic macular edema. World J Diabetes. 2014; 4(6):303-9. PMC: 3874490. DOI: 10.4239/wjd.v4.i6.303. View

13.

Sun J, Radwan S, Soliman A, Lammer J, Lin M, Prager S . Neural Retinal Disorganization as a Robust Marker of Visual Acuity in Current and Resolved Diabetic Macular Edema. Diabetes. 2015; 64(7):2560-70. PMC: 4477364. DOI: 10.2337/db14-0782. View

14.

Wells J, Glassman A, Ayala A, Jampol L, Aiello L, Antoszyk A . Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. N Engl J Med. 2015; 372(13):1193-203. PMC: 4422053. DOI: 10.1056/NEJMoa1414264. View

15.

Maturi R, Bleau L, Saunders J, Mubasher M, Stewart M . A 12-MONTH, SINGLE-MASKED, RANDOMIZED CONTROLLED STUDY OF EYES WITH PERSISTENT DIABETIC MACULAR EDEMA AFTER MULTIPLE ANTI-VEGF INJECTIONS TO ASSESS THE EFFICACY OF THE DEXAMETHASONE-DELAYED DELIVERY SYSTEM AS AN ADJUNCT TO BEVACIZUMAB COMPARED WITH.... Retina. 2015; 35(8):1604-14. DOI: 10.1097/IAE.0000000000000533. View

16.

Brown D, Schmidt-Erfurth U, Do D, Holz F, Boyer D, Midena E . Intravitreal Aflibercept for Diabetic Macular Edema: 100-Week Results From the VISTA and VIVID Studies. Ophthalmology. 2015; 122(10):2044-52. DOI: 10.1016/j.ophtha.2015.06.017. View

17.

Sadiq M, Soliman M, Sarwar S, Agarwal A, Hanout M, Demirel S . Effect of Vitreomacular Adhesion on Treatment Outcomes in the Ranibizumab for Edema of the Macula in Diabetes (READ-3) Study. Ophthalmology. 2015; 123(2):324-329. DOI: 10.1016/j.ophtha.2015.09.032. View

18.

Wells J, Glassman A, Jampol L, Aiello L, Antoszyk A, Baker C . Association of Baseline Visual Acuity and Retinal Thickness With 1-Year Efficacy of Aflibercept, Bevacizumab, and Ranibizumab for Diabetic Macular Edema. JAMA Ophthalmol. 2015; 134(2):127-34. PMC: 5567793. DOI: 10.1001/jamaophthalmol.2015.4599. View

19.

Krizova L, Kalousova M, Kubena A, Chrapek O, Chrapkova B, Sin M . Correlation of Vitreous Vascular Endothelial Growth Factor and Uric Acid Concentration Using Optical Coherence Tomography in Diabetic Macular Edema. J Ophthalmol. 2015; 2015:478509. PMC: 4664812. DOI: 10.1155/2015/478509. View

20.

Ting D, Cheung G, Wong T . Diabetic retinopathy: global prevalence, major risk factors, screening practices and public health challenges: a review. Clin Exp Ophthalmol. 2015; 44(4):260-77. DOI: 10.1111/ceo.12696. View