Alternating aflibercept, bevacizumab injections beneficial as maintenance therapy in AMD

Monthly alternating injections of aflibercept and bevacizumab (MAAB) for maintenance treatment in patients with neovascular age-related macular degeneration (AMD) prevented anatomical and functional deterioration when bimonthly aflibercept was insufficient, according to a study.

Researchers analyzed the outcomes of 72 patients with neovascular AMD who showed improvement with loading injections of aflibercept. In 24 worsening eyes, MAAB were administered; the remaining eyes were treated with aflibercept bimonthly.

The following were associated with worsening after extending the injection intervals:

-Baseline low retinal thickness
-Thick choroid
-Presence of intraretinal fluid

In the group of patients receiving MAAB visual improvement was lower than in patients treated with aflibercept bimonthly. Final visual outcomes were comparable.

The addition of bevacizumab stabilized the early fluctuation of retinal thickness. According to the authors, this helped maintain “long-term visual stability without increasing the risk of geographic atrophy or disciform scar until the second year.”

Amongst patients who had eyes that underwent prior treatment and eyes with polypoidal choroidal vasculopathy, there was a decreased response to the initial loading doses and worsening with the bimonthly treatment.

Reference
Lee J, Kim YN, Kim JG. Monthly Alternating Injections of Aflibercept and Bevacizumab for Neovascular Age-Related Macular Degeneration. J Clin Med. 2022;11(6):1543. doi: 10.3390/jcm11061543. PMID: 35329868; PMCID: PMC8950741.