Aflibercept treatment with treatment-extend regimen in bevacizumab-resistant nAMD: Real-life experience

PURPOSE: The aim of the study was to evaluate the anatomical and functional effectiveness of the treat-and-extend (TAE) regimen with intravitreal (IV) aflibercept treatment in neovascular age-related macular degeneration (nAMD) patients who responded anatomically poorly after three doses of IV bevacizumab injection.
METHODS: This observational, single-center, real-life study included adults aged at least 50 years with treatment-naïve nAMD and a best-corrected visual acuity (BCVA) between 25 and 75 Early Treatment of Diabetes Retinopathy Study (ETDRS) letter scores. Three loading doses of IV bevacizumab were administered to all patients, and patients with an anatomical poor re-sponse after three loading doses were included in the study. All patients received three doses of IV aflibercept and treatment was continued with the TAE regimen. The primary endpoint was the mean change in BCVA from baseline to week 52.
RESULTS: Thirty-six (48.6%) women and 38 (51.4%) men participated in this study, and the average age was 74.4±8.4 years. ETDRS letter gains were 5.5, 9.6, and 13.8 at weeks 12, 24, and 52, respectively. At week 52, a gain of 15 letters or more was detected in 34 of the patients (45.9%). The anatomical gains were 72.3 µm, 94.3 µm, and 116.7 µm at 12, 24, and 52 weeks, respectively. The mean number of injections performed was 8.2. The mean final interval was 8.8 weeks. The proportion of patients with 12 weeks or more between treatments was 16/74 (21.6%).
CONCLUSION: In treatment-naïve nAMD patients refractory to bevacizumab, IV aflibercept administered using the TAE regi-men improved and maintained functional and anatomical outcomes for 52 weeks.