Real-world Visual Acuity Outcomes for Patients with Naïve Neovascular Age-related Macular Degeneration Treated with Aflibercept, Ranibizumab, or Bevacizumab in the Republic of Korea

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2024 Oct 3

PMID 39361587

Authors

Yeo Jin Lee

Seungbum Kang

Jae Yon Won

Young Jung Roh

Ho Ra

Mee Yon Lee

Sung Pyo Park

Dong Hyun Jee

Affiliations

Soon will be listed here.

Abstract

Background: To compare the visual outcomes of different anti-vascular endothelial growth factor (VEGF) drugs, including aflibercept, ranibizumab, and bevacizumab, in a real-world setting in Korea.

Methods: We collected data from patients who received monotherapy using one of these three anti-VEGF drugs as naïve treatment after being diagnosed with neovascular age-related macular degeneration. The number of injections and visual acuity (VA) outcomes of each cohort were obtained and pairwise comparisons were performed using propensity score matching.

Results: A total of 254 aflibercept, 238 ranibizumab, and 282 bevacizumab treatment-naïve eyes were included. The mean VA change at 3 years for all cohorts combined was -1.8 letters, and the mean number of injections was 9.4. In the direct comparison of the three drugs, the mean change in the VA letter score was +2.0 letters for aflibercept and -11.7 letters for bevacizumab (P < 0.001). The number of aflibercept injections was significantly higher than the number of bevacizumab injections (P = 0.002). The visual outcomes for aflibercept and ranibizumab were +4.7 letters and -1.9 letters, respectively, and comparable results were obtained (P = 0.13). The VA outcomes for ranibizumab and bevacizumab were also not significantly different (P = 0.09). The numbers of injections for aflibercept, ranibizumab, and bevacizumab were 10.8, 6.7, and 8.8, respectively. Significant differences were observed between the injection frequencies comparisons of aflibercept and ranibizumab and ranibizumab and bevacizumab (P < 0.001 and P = 0.002, respectively).

Conclusions: In the Korean clinical medical environment, which included various confounding factors, especially socioeconomic ones, the aflibercept VA outcome was significantly better than that of bevacizumab, and aflibercept injections were the most numerous. These real-world data imply that the drug effect as well as the environment in which the drug can be sufficiently used affected patient final VA scores.

References

Providencia J, Rodrigues T, Oliveira M, Bernardes J, Marques J, Murta J . Real-World Results of Aflibercept versus Ranibizumab for the Treatment of Exudative AMD Using a Fixed Regimen. Biomed Res Int. 2018; 2018:9276580. PMC: 6011153. DOI: 10.1155/2018/9276580. View

Verbraak F, Ponsioen D, Tigchelaar-Besling O, Nguyen V, Gillies M, Barthelmes D . Real-world treatment outcomes of neovascular Age-related Macular Degeneration in the Netherlands. Acta Ophthalmol. 2020; 99(6):e884-e892. PMC: 8519105. DOI: 10.1111/aos.14712. View

Martin D, Maguire M, Fine S, Ying G, Jaffe G, Grunwald J . Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results. Ophthalmology. 2012; 119(7):1388-98. PMC: 3389193. DOI: 10.1016/j.ophtha.2012.03.053. View

Kodjikian L, Souied E, Mimoun G, Mauget-Faysse M, Behar-Cohen F, Decullier E . Ranibizumab versus Bevacizumab for Neovascular Age-related Macular Degeneration: Results from the GEFAL Noninferiority Randomized Trial. Ophthalmology. 2013; 120(11):2300-9. DOI: 10.1016/j.ophtha.2013.06.020. View

Gillies M, Hunyor A, Arnold J, Guymer R, Wolf S, Pecheur F . Macular Atrophy in Neovascular Age-Related Macular Degeneration: A Randomized Clinical Trial Comparing Ranibizumab and Aflibercept (RIVAL Study). Ophthalmology. 2019; 127(2):198-210. DOI: 10.1016/j.ophtha.2019.08.023. View

Quillen D . Common causes of vision loss in elderly patients. Am Fam Physician. 1999; 60(1):99-108. View

Kovach J, Schwartz S, Flynn Jr H, Scott I . Anti-VEGF Treatment Strategies for Wet AMD. J Ophthalmol. 2012; 2012:786870. PMC: 3317200. DOI: 10.1155/2012/786870. View

Congdon N, OColmain B, Klaver C, Klein R, Munoz B, Friedman D . Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol. 2004; 122(4):477-85. DOI: 10.1001/archopht.122.4.477. View

Heier J, Brown D, Chong V, Korobelnik J, Kaiser P, Nguyen Q . Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration. Ophthalmology. 2012; 119(12):2537-48. DOI: 10.1016/j.ophtha.2012.09.006. View

10.

Holz F, Tadayoni R, Beatty S, Berger A, Cereda M, Cortez R . Multi-country real-life experience of anti-vascular endothelial growth factor therapy for wet age-related macular degeneration. Br J Ophthalmol. 2014; 99(2):220-6. PMC: 4316940. DOI: 10.1136/bjophthalmol-2014-305327. View

11.

Figueras-Roca M, Parrado-Carrillo A, Nguyen V, Casaroli-Marano R, Moll-Udina A, Gillies M . Treat-and-extend versus fixed bimonthly treatment regimens for treatment-naive neovascular age-related macular degeneration: real world data from the Fight Retinal Blindness registry. Graefes Arch Clin Exp Ophthalmol. 2020; 259(6):1463-1470. DOI: 10.1007/s00417-020-05016-9. View

12.

Pham B, Thomas S, Lillie E, Lee T, Hamid J, Richter T . Anti-vascular endothelial growth factor treatment for retinal conditions: a systematic review and meta-analysis. BMJ Open. 2019; 9(5):e022031. PMC: 6549720. DOI: 10.1136/bmjopen-2018-022031. View

13.

Corazza P, DAlterio F, Kabbani J, Alam M, Mercuri S, Orlans H . Long-term outcomes of intravitreal anti-VEGF therapies in patients affected by neovascular age-related macular degeneration: a real-life study. BMC Ophthalmol. 2021; 21(1):300. PMC: 8364685. DOI: 10.1186/s12886-021-02055-6. View

14.

Schauwvlieghe A, Dijkman G, Hooymans J, Verbraak F, Hoyng C, Dijkgraaf M . Comparing the Effectiveness of Bevacizumab to Ranibizumab in Patients with Exudative Age-Related Macular Degeneration. The BRAMD Study. PLoS One. 2016; 11(5):e0153052. PMC: 4874598. DOI: 10.1371/journal.pone.0153052. View

15.

Mehta H, Tufail A, Daien V, Lee A, Nguyen V, Ozturk M . Real-world outcomes in patients with neovascular age-related macular degeneration treated with intravitreal vascular endothelial growth factor inhibitors. Prog Retin Eye Res. 2018; 65:127-146. DOI: 10.1016/j.preteyeres.2017.12.002. View

16.

Chakravarthy U, Harding S, Rogers C, Downes S, Lotery A, Culliford L . Alternative treatments to inhibit VEGF in age-related choroidal neovascularisation: 2-year findings of the IVAN randomised controlled trial. Lancet. 2013; 382(9900):1258-67. DOI: 10.1016/S0140-6736(13)61501-9. View

17.

Khanani A, Skelly A, Bezlyak V, Griner R, Torres L, Sagkriotis A . SIERRA-AMD: A Retrospective, Real-World Evidence Study of Patients with Neovascular Age-Related Macular Degeneration in the United States. Ophthalmol Retina. 2019; 4(2):122-133. DOI: 10.1016/j.oret.2019.09.009. View

18.

Berg K, Pedersen T, Sandvik L, Bragadottir R . Comparison of ranibizumab and bevacizumab for neovascular age-related macular degeneration according to LUCAS treat-and-extend protocol. Ophthalmology. 2014; 122(1):146-52. DOI: 10.1016/j.ophtha.2014.07.041. View

19.

Ehlers J . The MANTA 1-year results: the anti-VEGF debate continues. Br J Ophthalmol. 2012; 97(3):248-50. DOI: 10.1136/bjophthalmol-2012-302489. View

20.

Lotery A, Griner R, Ferreira A, Milnes F, Dugel P . Real-world visual acuity outcomes between ranibizumab and aflibercept in treatment of neovascular AMD in a large US data set. Eye (Lond). 2017; 31(12):1697-1706. PMC: 5733295. DOI: 10.1038/eye.2017.143. View