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Retina

Treatment Switch for Poor Responders to Macular Edema Therapy Evaluated

Posted on January 15, 2019

Switching to aflibercept may improve visual acuity letter score (VALS) and central subfield thickness (CST) changes in eyes with central retinal or hemiretinal vein occlusion that have a poor response to bevacizumab, according to a secondary analysis of the SCORE2 study involving 49 individuals. Still, the results should be interpreted cautiously.

Changes in VALS and CST were assessed from month 6 to 12 among eyes with a poor response at month 6 to monthly dosing of aflibercept or bevacizumab.  Eyes with a poor response to bevacizumab at month 6 were switched to aflibercept, and those with a poor response to aflibercept at month 6 were switched to dexamethasone. Among the results:

  • Aflibercept treatment failed in 14 of 49 participants at month 6.
  • Bevacizumab treatment failed in 35 of 49 participants.
  • In eyes with treatment switched from aflibercept to dexamethasone, the estimated mean change from month 6 to 12 in VALS was not statistically significant.
  • In eyes with treatment switched from bevacizumab to aflibercept, the estimated mean change from month 6 to 12 in VALS was 10.27.
  • Average CST change was −125.4 μm.

The authors noted that because the absolute number of eyes with a poor response to aflibercept was low, these results should be interpreted cautiously and preclude a definitive assessment of whether the switching strategy is superior to continuing aflibercept treatment.

Ip MS, Oden NL, Scott IU, et al. Month 12 Outcomes After Treatment Change at Month 6 Among Poor Responders to Aflibercept or Bevacizumab in Eyes with Macular Edema Secondary to Central or Hemiretinal Vein Occlusion: A Secondary Analysis of the SCORE2 Study. JAMA Ophthalmol. [Published online December 27, 2018] doi: 10.1001/jamaophthalmol.2018.6111

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