Long-Term Efficacy of Ranibizumab and Aflibercept Similar

Long-term efficacy of ranibizumab and aflibercept are nearly identical in the treatment of age-related macular degeneration (AMD), with approximately 50%of patients treated with either anti-vascular endothelial growth factor (VEGF) drug demonstrating sustained or improved visual acuity nearly 7 years after starting an intensive 2-year therapy, according to an analysis published in BMC Ophthalmology. However, a remarkable proportion of eyes undergoing these treatments experienced severely reduced best-corrected visual acuity (BCVA), underlying the need for long-term follow-ups and prolonged intensive therapy.

Researchers used data from the Vascular Endothelial Growth Factor (VEGF) Trap-Eye: Investigation of Efficacy and Safety in Wet Age-Related Macular Degeneration (VIEW 2, ClinicalTrials.gov Identifier: NCT00637377, ClinicalTrials.gov Identifier: NCT05678517) trial. 

The investigation into long-term efficacy of ranibizumab and aflibercept included 47 eyes of 47 patients (14 treated with ranibizumab; 33 treated with aflibercept). Researchers reviewed 7-year outcomes of 2-year intensive treatments followed by 5 years of a low number of injections. They then compared the long-term efficacy of ranibizumab and aflibercept treated groups.

Participants received an average of 17.8±3.0 injections, with 30% receiving further injections during post-intensive years; an average of 5.7±4.5. Thus, 70% did not undergo more intravitreal medication.

The researchers found 55% of all participants (43% in the ranibizumab-treated group; 60% in the aflibercept-treated group) improved or maintained best-corrected visual acuity (BCVA), losing no more than 10 early treatment diabetic retinopathy study (ETDRS) letters. Participants of either group exhibited no significant differences in BCVA at the beginning of VIEW 2 (P =.88), or after follow-up (P =.40).

The investigation also identified a significant correlation between final visual acuity and atrophy area (P <.001), with 96% of eyes showing macular atrophy, with a mean area of 7.22±6.31mm2. The researchers identified no significant differences between study arms (P =.47). After follow-up, 7 eyes, or 15% displayed intra- or subretinal fluid, indicating disease activity.

“We observed long-term vision improvement in a remarkable proportion of patients, especially in the aflibercept group despite the very low number of injections after the second year,” report the researchers.

Prior studies evaluating the long-term efficacy of ranibizumab and aflibercept have shown a mean 8.6 letter loss after 7 years, even with continued treatment from years 2 to 7 years, as well as a 7.3 to 11.9 letter decline in years 3 to 10, despite an average of 2.8 injections per year. Prior research also shows a 12.1 letter gain at 7 years after 5 or more years of fixed-interval 4- to 8-week therapy. Current investigators speculate these data may affirm a longer fixed interval regimen for exudative AMD. 

Limitations of this analysis included a relatively small sample, non-standardized regimen following intensive treatment.

Disclosure: Some study authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.