Efficacy of aflibercept on exudative age-related macular degeneration in patients exhibiting complete ranibizumab resistance and tachyphylaxis

Gokcen Gokce, Ali Hakan Durukan, Mehmet Talay Koylu, Murat Kucukevcilioglu
2016 Arquivos Brasileiros de Oftalmologia  
Purpose: The present study compared the efficacy of aflibercept for neovascular age-related macular degeneration (NV-AMD) in patients with complete ranibizumab resistance and tachyphylaxis. Methods: Forty-four eyes of 38 neovascular age-related macular degeneration patients were evaluated. Eyes were divided into a complete resistance group (n=23 eyes) and tachyphylaxis group (n=21 eyes). Results: After three injections, eight (38.1%) patients in the tachyphylaxis group and nine (39.1%) in the
more » ... mplete resistance group presented with macular dryness. After the first injection of aflibercept, the mean visual acuity improved significantly in the tachyphylaxis group (p=0.018) but remained unchanged in the complete resistance group (p=0.37). There was a non-significant trend towards improved mean visual acuity in both groups after the second and third injections relative to the acuity at the final visit for ranibizumab treatment. In the tachyphylaxis group, the presence of subfoveal pigmented epithelium detachment (PED) decreased significantly after intravitreal aflibercept treatment. Conclusions: Although treatment with aflibercept yielded generally positive anatomical results in both groups, no significant increase in visual acuity was achieved. RESUMO Objetivo: O presente estudo comparou a eficácia do aflibercept na degeneração macular neovascular relacionada à idade (NV-AMD) com de resistência completa ao ranibizumab e taquifilaxia ao ranibizumab. Método: Quarenta e quatro olhos de 38 pacientes com degeneração macular neovascular relacionada à idade foram inscritos. Eles foram divididos em dois grupos: grupo de resistência completa (n=23 olhos) e grupo taquifilaxia (n=21 olhos). Resultados: Depois de três injeções, 8 (38,1%) olhos no grupo de taquifilaxia e 9 (39,1%) olhos no grupo de resistência completa, apresentaram mácula seca. Após a primeira injeção de aflibercept, a acuidade visual média melhorou significativamente no grupo taquifilaxia (p=0,018) e manteve-se inalterada no grupo de resistência completa (p=0,37). Houve uma tendência de melhora da acuidade visual média em ambos os grupos após a segunda e terceira injeções em comparação com a última visita do tratamento com ranibizumab, mas isso não foi estatisticamente significativo. A presença de descolamento do epitélio pimentado subfoveal (PED) em olhos com taquifilaxia ao ranibizumab diminuiu significativamente após o tratamento aflibercept intravítreo. Conclusões: Embora o tratamento com aflibercept tenha mostrado resultados anatômicos positivas em ambos os grupos, não foi obtida melhora significativa da acuidade visual. Descritores: Inibidores de angiogênese; Degeneração macular; Ranibizumab; Taquifilaxia; Fator A de crescimento do endotélio vascular Arq Bras Oftalmol. 2016;79(6):384-9 AMD cases who develop tachyphylaxis to anti-VEGFs (21, 22) . In contrast to previous studies, we aimed to demonstrate the short-term effectiveness of intravitreal aflibercept therapy in patients who had exhibited complete resistance to ranibizumab treatment; in other words, we included patients who were completely non-responsive from the first dose, as well as those who developed tachyphylaxis to ranibizumab. The present study compared these two groups. METHODS This interventional clinical study included 44 eyes of 38 patients with exudative AMD and complete ranibizumab (Lucentis®, Genentech, Inc., South San Francisco, CA, USA) resistance or ranibizumab tachyphylaxis and subsequently received three aflibercept (Eylea®, Regeneron, Tarrytown, NY, USA) injections and were followed up for 3 months. This study was conducted in accordance with the tenets of the Declaration of Helsinki, after receiving approval from the institutional ethics review board.
doi:10.5935/0004-2749.20160109 pmid:28076566 fatcat:mag44ferxbgjrlkrduh6kvqphm