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Clinical correlation to differences in ranibizumab and aflibercept vascular endothelial growth factor suppression times
  1. Sascha Fauser,
  2. Philipp S Muether
  1. Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
  1. Correspondence to Dr Philipp S Muether, Department of Ophthalmology, University of Cologne, Kerpener Strasse 62, Cologne 50924, Germany; philmuether{at}


Aim To determine clinical correlations to intraocular vascular endothelial growth factor A (VEGF-A) suppression times (VSTs) on the treatment of neovascular age-related macular degeneration (nAMD) with ranibizumab (Lucentis) or aflibercept (Eylea).

Methods Seven of 89 treatment-naïve nAMD eyes showed persistent choroidal neovascular membrane (CNV) activity throughout a spectral domain optical coherence tomography (SD-OCT)-driven pro re nata (PRN) regimen of intravitreal ranibizumab injections over 28±4 months. The treatment was switched to PRN aflibercept injections and patients were followed for another 15±2 months. A total of 160 aqueous humour specimens were collected before the intravitreal injections, and their VEGF-A concentrations were assayed by Luminex multiplex bead analysis (Luminex, Austin, Texas, USA). Intraocular VEGF-A concentrations were correlated to CNV activity shown by SD-OCT.

Results The mean duration of suppression of VEGF-A concentrations in aqueous humour below the lower limit of quantification of our assay was 34±5 (26–69) days for ranibizumab and 67±14 (49–89) days for aflibercept (p<0.001). The percentual reduction of central retinal volume (CRV) 6 weeks after injection was higher for aflibercept compared with ranibizumab (p=0.009). The time point of clinical re-activity occurred about 50% earlier than the respective VST for each ranibizumab and aflibercept.

Conclusions The VST under aflibercept treatment exceeded that under ranibizumab treatment by a factor of 2. This difference correlated with differential clinical CRV reduction 6 weeks after the respective injection. For both medications, clinical activity was found at a time point as early as 50% of the individual VST.

Trial registration number NCT01213667, post-results

  • Treatment Medical
  • Retina
  • Pharmacology
  • Neovascularisation
  • Macula

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  • Contributors SF and PSM have both designed the study, acquired the data, analysed the data, written the article and approved the final version.

  • Competing interests SF reports grants and personal fees from Novartis, grants and personal fees from Bayer, personal fees from Quantel, outside the submitted work; PSM reports personal fees from Novartis, personal fees from Bayer, personal fees from Heidelberg Engineering, outside the submitted work.

  • Ethics approval Ethics committee of the University of Cologne (reference number 11-027).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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