Abstract
Background and objective
To evaluate the proportion of patients achieving a 12-week (q12) aflibercept dosing interval in patients with neovascular age-related macular degeneration (nAMD).
Patients and methods
Retrospective, comparative, non-randomised electronic medical record (EMR) database study of the Moorfields database of treatment-naïve nAMD eyes. Extraction criteria included at least 7 aflibercept injections in first year of treatment, AMD in the diagnosis field of EMR, and minimum of 1 year follow-up data.
Results
There were 2416 eyes of 2163 patients started on anti-vascular endothelial growth factor (anti-VEGF) between 01-11-2013 & 14-02-2020 who had received at least 7 aflibercept intravitreal injections (electronic database accessed March 2021). Of these, 1674 (68%) eyes of 1537 patients had at least one q12 dosing interval (>=84 and < =98 days between injections) during the first 2 years of treatment. This included 926 (61.8%) female patients and 856 (right eyes age at 1st injection), 936 (62.4%) Caucasian, and 32 (2.1%) Afro-Caribbean patients. The median time to the first q12 injection (95% confidence interval) was 1.76 years (1.70–1.86) with mean (±SD) of 11.8 (±6.0) injections. Visual acuity (ETDRS letters) of the eyes without q12 injection and eyes with a q12 injection was 57.9 ± 14.7 and 56.7 ± 14.8 respectively at baseline, 61.4 ± 18.1 and 63.0 ± 15.9 respectively at 12 months and 61.2 ± 20.1 and 61.1 ± 17.8 respectively at 24 months.
Conclusion
68% of eyes were able to achieve a q12 injection dose within the first 2 years of treatment. Eyes achieving a q12 injection in the first 2 years achieved a similar visual acuity outcome at both 1 and 2-year follow-up to those unable to do so, with a fewer number of total injections.
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DJF designed the study, collected the study data and completed the analysis. DH designed the study and wrote the manuscript; SW and TK provided critical appraisal of the manuscript. PP, PK and KB designed the study and provided critical appraisal of the manuscript.
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Dr. Patel, Dr. Keane, and Dr. Balaskas have received a proportion of their funding from the Department of Health’s NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology. Dr. Keane has acted as a consultant for DeepMind, Roche, Novartis, and Apellis and is an equity owner in Big Picture Medical. He has received speaker fees from Heidelberg Engineering, Topcon, Allergan, and Bayer. Dr. Keane is supported by a Moorfields Eye Charity Career Development Award (R190028A) and a UK Research & Innovation Future Leaders Fellowship (MR/T019050/1). Dr. Balakas has received speaker fees from Novartis, Bayer, Alimera, Allergan, and Heidelberg, consulting fees from Novartis and Roche, and research support from Apellis, Roche, Novartis, and Bayer. Dr. Patel has received speaker fees from Novartis, Bayer, Topcon, and Heidelberg, consulting fees from Novartis, Bayer, Oxford Bioelectronics, and Roche, and research support from Bayer. Dr. Fu has acted as consultant for Abbvie, Allergan, DeepMind.
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Fu, D.J., Hanumunthadu, D., Keenan, T.D.L. et al. Characterising treatment outcomes of patients achieving quarterly aflibercept dosing for neovascular age-related macular degeneration: real-world clinical outcomes from a large tertiary care centre. Eye 37, 779–784 (2023). https://doi.org/10.1038/s41433-022-02220-1
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DOI: https://doi.org/10.1038/s41433-022-02220-1
