Офтальмохирургия (Nov 2018)
Comparison of the effectiveness of various protocols for the transition to aflibercept with tachyphylaxis for ranibizumab in patients with neovascular AMD
Abstract
Purpose. Expanding the range of angiogenesis inhibitors allows the creation of treatment regimens with a change in the drug to increase the effectiveness of treatment. The aim of the study was to perform a comparative analysis of the efficacy of different regimes of antiangiogenic therapy for neovascular age-related macular degeneration (nAMD) with a change in inhibitor of angiogenesis from ranibizumab to aflibercept.Material and methods. A prospective interventional comparative non-masked controlled clinical trial was conducted in 4 groups of subjects who received at least 5 intravitreal injection of ranibizumab (IVR). Continuation of treatment was carried out in 1-3 groups with aflibercept, in group 1 with an initial course of 3 IVI and then 1 IVI every 2 months, in the second group without an initial course, 1 IVI every 2 months, in group 3 in PRN mode, 4 the group was treated with ranibizumab in PRN mode. Patients were monitored for 11 months, assessed by BCVA (best corrected visual acuity) and TCR (thickness of the centr al retina).Results. In group 1, 12 patients (14 eyes) completed, 7 IVI completed, TCR decreased by 131±78 μm (p<0.05). In group 2, 18 patients (19 eyes) completed, 6 of the IVI completed, decreased by 131±58 μm (p<0.05). In the 3rd group, 14 patients (16 eyes) completed the study, the average number of IVI was 4.1±1.9, the TCR did not change significantly. In the control group, a study of 25 patients was completed, an average of 4.6±2.1 IVI was performed, no significant changes in TCR were observed. There were no significant changes in BCVA (best corrected visual acuity) in any group, however, the frequency of improvement in visual acuity was higher in 1-3 groups (37.5-42.8%) compared with the control 24.0%. Conclusions. When the angiogenesis inhibitor with ranibizumab is switched to aflibercept in the phase of maintaining a regular antiangiogenic therapy for neovascular age-related macular degeneration (nAMD), the IVI regimen provides the best result with the least amount of IVI every 2 months.
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