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Is switching anti-VEGF agents beneficial after initial suboptimal response in nAMD?

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Although it has been suggested that patients with neovascular age-related macular degeneration (nAMD) who experience suboptimal response to initial anti-vascular endothelial growth factor (anti-VEGF) therapy be switched to an alternative agent, a post hoc analysis of the ARIES clinical trials shows comparable visual gains by patients who met hypothetical switch criteria to patients who responded well to treat-and-extend intravitreal aflibercept (IVT-AFL).

Patients with treatment-naïve nAMD identified as meeting criteria for an early hypothetical switch from treat-and-extend intravitreal aflibercept (IVT-AFL) were followed for 104 weeks. Criteria included the presence of central intraretinal and/or subretinal fluid at week 8 or 24, with/without a next planned treatment interval ≤ 8 weeks, and with/without gains in best-corrected visual acuity (BCVA) ≤ 5 letters (with absolute BCVA < 70 letters).

Depending on which criteria was used, between 8% and 46% of patients qualified as hypothetical switchers, with most meeting the criteria due to the presence of central subretinal fluid.

Regardless of criteria, BCVA outcomes were not worse in the hypothetical switchers.

Researchers used criteria of intraretinal/subretinal fluid at week 24 and a next planned treatment interval ≤ 8 weeks to compare mean changes in BCVA (letters) from baseline in hypothetical switchers and non-switchers were.

From baseline to week 24, mean changes in BCVA (letters) in hypothetical switchers was + 6.1 (95% confidence interval [CI] 3.4, 8.8) compared to + 6.6 (95% CI 4.7, 8.6) in non-switchers. At weeks 52 and 104, mean change was + 8.2 (95% CI 5.0, 11.3) and + 5.7 (95% CI 1.3, 10.1), respectively, in hypothetical switchers and + 7.5 (95% CI 5.3, 9.7) and + 3.4 (95% CI 0.1, 6.7), respectively, in non-switchers.

Tuerksever C, Somfai GM, Oesch S, et al. Hypothetical Switch of Anti-Vascular Endothelial Growth Factor in Neovascular Age-Related Macular Degeneration: An ARIES Post Hoc Analysis. Ophthalmol Ther. 2022; doi: 10.1007/s40123-021-00448-w. Epub ahead of print. PMID: 35066801.