TY - JOUR T1 - Anatomical and functional outcomes following switching from aflibercept to ranibizumab in neovascular age-related macular degeneration in Europe: SAFARI study JF - British Journal of Ophthalmology JO - Br J Ophthalmol DO - 10.1136/bjophthalmol-2019-314251 SP - bjophthalmol-2019-314251 AU - Richard P Gale AU - Ian Pearce AU - Nicole Eter AU - Faruque Ghanchi AU - Frank G Holz AU - Steffen Schmitz-Valckenberg AU - Konstantinos Balaskas AU - Ben J L Burton AU - Susan M Downes AU - Haralabos Eleftheriadis AU - Sheena George AU - David Gilmour AU - Robin Hamilton AU - Andrew J Lotery AU - Nishal Patel AU - Priya Prakash AU - Cynthia Santiago AU - Saju Thomas AU - Deepali Varma AU - Gavin Walters AU - Michael Williams AU - Armin Wolf AU - Rosina H Zakri AU - Franklin Igwe AU - Filis Ayan Y1 - 2019/08/05 UR - http://bjo.bmj.com/content/early/2019/08/04/bjophthalmol-2019-314251.abstract N2 - Background/Aims Prospective data on switching anti-vascular endothelial growth factors in patients with neovascular age-related macular degeneration (nAMD) who have previously shown no/partial response are limited. This prospective study assessed the effect of switching from aflibercept to ranibizumab on anatomical and functional outcomes in patients with persistent/recurrent disease activity.Methods SAFARI (NCT02161575) was a 6-month, prospective, single-arm study conducted in the UK and Germany. Patients, meeting strict eligibility criteria for one of two subgroups (primary treatment failure or suboptimal treatment response), received 3 monthly intravitreal ranibizumab injections (0.5 mg). Thereafter, ranibizumab was administered pro re nata at monthly visits. The primary endpoint was change from baseline (CfB) to day 90 in central subfield retinal thickness (CSRT). Best-corrected visual acuity (BCVA) and retinal morphology parameters were assessed.Results One hundred patients were enrolled (primary treatment failure, 1; suboptimal treatment response, 99). In the overall population, there was a significant CfB in median CSRT of −30.75 µm (95% CI −59.50,–20.50; p<0.0001) to day 90. Improvements were also observed in other quantitative and qualitative optical coherence tomography parameters. In Early Treatment Diabetic Retinopathy Study letters assessed by category, 55% and 59% of patients gained 0–≥15 letters versus baseline at day 90 and day 180, respectively. However, mean improvements in BCVA (CfB) to each time point were small (≤2 letters). No new safety signals were identified.Conclusion Switching from aflibercept to ranibizumab led to a significant improvement in CSRT, with ~60% experiencing stabilised/improved BCVA. Therefore, patients with nAMD who have shown a suboptimal response to aflibercept may benefit from switching to ranibizumab. ER -