PT - JOURNAL ARTICLE AU - Aaron Y Lee AU - Cecilia S Lee AU - Catherine A Egan AU - Clare Bailey AU - Robert L Johnston AU - Salim Natha AU - Robin Hamilton AU - Rehna Khan AU - Sahar Al-Husainy AU - Christopher Brand AU - Toks Akerele AU - Martin Mckibbin AU - Louise Downey AU - Adnan Tufail TI - UK AMD/DR EMR REPORT IX: comparative effectiveness of predominantly as needed (PRN) ranibizumab versus continuous aflibercept in UK clinical practice AID - 10.1136/bjophthalmol-2016-309818 DP - 2017 Dec 01 TA - British Journal of Ophthalmology PG - 1683--1688 VI - 101 IP - 12 4099 - http://bjo.bmj.com/content/101/12/1683.short 4100 - http://bjo.bmj.com/content/101/12/1683.full SO - Br J Ophthalmol2017 Dec 01; 101 AB - Aims To compare the effectiveness of continuous aflibercept versus pro re nata (PRN) ranibizumab therapy for neovascular age-related macular degeneration (nAMD).Methods Multicentre, national electronic medical record (EMR) study on treatment naive nAMD eyes undergoing PRN ranibizumab or continuous (fixed or treat and extend (F/TE)) aflibercept from 21 UK hospitals. Anonymised data were extracted, and eyes were matched on age, gender, starting visual acuity (VA) and year of starting treatment. Primary outcome was change in vision at 1 year.Results 1884 eyes (942 eyes in each group) were included. At year 1, patients on PRN ranibizumab gained 1.6 ETDRS (Early Treatment Diabetic Retinopathy Study) letters (95% CI 0.5 to 2.7, p=0.004), while patients on F/TE aflibercept gained 6.1 letters (95% CI 5.1 to 7.1, p=2.2e-16). Change in vision at 1 year of the F/TE aflibercept group was 4.1 letters higher (95% CI 2.5 to 5.8, p=1.3e-06) compared with the PRN ranibizumab group after adjusting for age, starting VA, gender and year of starting therapy. The F/TE aflibercept group had significantly more injections compared with the PRN ranibizumab group (7.0 vs 5.8, p<2.2e-16), but required less clinic visits than the PRN ranibizumab group (10.8 vs 9.0, p<2.2e-16). Cost-effectiveness analysis showed an incremental cost-effectiveness ratio of 58 047.14 GBP/quality-adjusted life year for continuous aflibercept over PRN ranibizumab.Conclusion Aflibercept achieved greater VA gains at 1 year than ranibizumab. The observed VA differences are small and likely to be related to more frequent treatment with aflibercept, suggesting that ranibizumab should also be delivered by F/TE posology.