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• Effects of switching from ranibizumab to aflibercept in eyes with exudative age-related macular degeneration
  Mihai Calugaru
  Published on: 29 June 2016

• Published on: 29 June 2016

  Effects of switching from ranibizumab to aflibercept in eyes with exudative age-related macular degeneration

  • Mihai Calugaru, Professor Ophthalmology
  • Other Contributors:
    • Dan Calugaru

  Effects of switching from ranibizumab to aflibercept in eyes with exudative age-related macular degeneration Dan C?lug?ru, Mihai C?lug?ru Department of Ophthalmology, Univ of Medicine Cluj-Napoca/Romania

  Re: Effects of switching from ranibizumab to aflibercept in eyes with exudative age-related macular degeneration. Barthelmes et al. Br J Ophthalmol published online on March 18, 2016;doi:10.1136/bjophthalmol- 20...

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  Effects of switching from ranibizumab to aflibercept in eyes with exudative age-related macular degeneration Dan C?lug?ru, Mihai C?lug?ru Department of Ophthalmology, Univ of Medicine Cluj-Napoca/Romania

  Re: Effects of switching from ranibizumab to aflibercept in eyes with exudative age-related macular degeneration. Barthelmes et al. Br J Ophthalmol published online on March 18, 2016;doi:10.1136/bjophthalmol- 2015-308090.

  Dear Editor

  The interesting article by Barthelmes et al [1] carries several shortcomings that prevent the validation and extrapolation of their results and that can be specifically summarized as follows:

  1. The study was retrospectively conducted with the existence of a bias due to the lack of a uniform definite treatment scheme for injections and reinjections, the decision to treat being left at the discretion of the treating physicians, Additionally, 26 eyes were switched back to the original treatment and two different treatment regimens were chosen, namely, the treat-and-extend approach in 59% of the eyes and the monthly pro re nata algorithm to the rest of the eyes.

  2 The aggressiveness of the neovascular age-related macular degeneration (nAMD) was graded taking into account the fluoreiscein angiography features. The assessment process should have included the optical coherence tomography (OCT) data as well.

  3. The analysis of the final outcomes of this study should have been carried out considering the current assertion according to which evaluation of the outcomes has to be guided by the anatomical measure data with the visual changes as a secondary guide [2] and not vice versa as Barthelmes et al [1] have approached.

  4. There were no data on the proportion of eyes considered "dry" on OCT as per criterion of foveal thickness < 320 ?m [3] nor on the anatomical types of the macular edema (subretinal fluid/cystic changes within neurosensory retina). Except for the morphological types of the choroidal neovascular membrane lesions presented in details, nothing was stated referring to the other anatomical types of the neovascular maculopathy including serous and/or hemorrhagic detachment of the neurosensory retina or retinal pigment epithelium (RPE), retinal hard exudates, subretinal and sub-RPE fibrovascular proliferation, and subretinal fibrosis, before and after switching to aflibercept (Eylea; Regeneron Pharmaceuticals Tarrytown, NY, USA.

  5. The design of this study has been deprived of a real washout period which is essential between the two periods of treatment in terms of aliased effects. Given that this washout period was not precisely delimited, the impact of the significant carryover effects may be confounded with direct treatment effects, in the sense that these effects could not be estimated separately being able to bias the interpretion of data analysis.

  Altogether, regardless of the anti-VEGF agents used (ranibizumab [Lucentis, Genentech Inc., South San Francisco, CA, USA]/bevacizumab [Avastin, Genentech Inc.,]/aflibercept), the efficacy of therapy depends primarily on the precociousness of the therapy after nAMD onset. References 1. Barthelmes D, Campain A, Nguyen P, et al. Effects of switching from ranibizumab to aflibercept in eyes with exudative age-related macular degeneration. Br J Ophthalmol2016, online first published on March 18, 2016;doi:10.1136/bjophthalmol-2015-308090.. 2. Freund KB, Korobelnik JF, Deveny R, et al. Treat-and-extend regimens with anti-VEGF agents in retinal diseases. A literature review and consensus recommendations. Retina 2015;35:1489-1506.. 3. Gover S, Murthy RK, Brar VS, et al. Normative data for macular thickness by high-definition spectral-domain optical coherence tomography (spectralis).Am J Ophthalmol2009;148:266-271.

  Conflict of interest: None declared

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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