J Korean Ophthalmol Soc.  2019 Jan;60(1):40-46. 10.3341/jkos.2019.60.1.40.

Clinical Changes after Switching from Ranibizumab/Aflibercept to Bevacizumab in Exudative Age-related Macular Degeneration

• Lee IH
• Lee JJ
• Kwon HJ
• Park SW
• Lee JE

• KMID: 2431838
• DOI: http://doi.org/10.3341/jkos.2019.60.1.40

Abstract

PURPOSE
This study was performed to investigate the changes in clinical findings after switching from ranibizumab or aflibercept to bevacizumab due to the limited number of insured injections in patients with exudative age-related macular degeneration (ARMD).
METHODS
The study population consisted of patients who had undergone intravitreal injection of ranibizumab or aflibercept for ≥ 6 months and were then treated with bevacizumab for ≥ 6 consecutive months for exudative ARMD. We evaluated best-corrected visual acuity, central subfield macular thickness, disease activity, and the number of injections for one year at the time of switching the drugs.
RESULTS
Forty patients (26 men and 14 women) were included in the analysis. The mean age was 71.9 (56-89) years old, with typical ARMD in 23 eyes, polypoidal choroidal vasculopathy in 15 eyes, and retinal angiomatous proliferation in two eyes. The number of injections for 6 months increased from 2.3 to 2.9 after switching the drugs (p < 0.001). Visual acuity was not significantly different between 6 months before and at the time of switching (LogMAR 0.55 ± 0.34 and 0.52 ± 0.27, respectively) (p = 0.300), but decreased significantly to 0.57 ± 0.34 at 6 months after switching (p = 0.018). There were no significant differences in central subfield macular thickness or disease activity.
CONCLUSIONS
Bevacizumab required more injections to achieve similar anatomical outcomes in patients with exudative ARMD treated with ranibizumab or aflibercept, and visual acuity decreased despite anatomical stability.

Keyword

Aflibercept; Age-related macular degeneration; Bevacizumab; Intravitreal injections; Ranibizumab

MeSH Terms

Bevacizumab*
Choroid
Humans
Intravitreal Injections
Macular Degeneration*
Male
Ranibizumab
Retinaldehyde
Visual Acuity
Bevacizumab
Ranibizumab
Retinaldehyde

Figure

• 

  Figure 1 Visual acuity and central subfield macular thickness (CSMT) before and after 6 months from switching to bevacizumab from ranibizumab/aflibercept for treating exudative age-related macular degeneration. (A) Visual acuity. (B) Visual acuity changes comparing to when the drug was switched. (C) CSMT measured using optical coherence tomography. ARMD = age-related macular degeneration; PCV = polypoidal choroidal vasculopathy; m = month. *p<0.05, comparing to the previous visit.

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