Neovascular age-related macular degeneration treated with ranibizumab or aflibercept in the same large clinical setting: visual outcome and number of injections

Purpose: To study visual outcome and number of annual injections in treatment-naive patients with neovascular age-related macular degeneration (nAMD) before and after a change in first-line therapy from ranibizumab to aflibercept in a high-volume clinical practice. Methods: This was a retrospective chart review of routine clinical practice. The study included 1027 treatment-naive patients, 559 of whom started intravitreal ranibizumab therapy in 2011-2012 and 468 of whom started intravitreal aflibercept therapy in 2013-2014, a fixed loading dose of three injections followed by a pro re nata treatment regimen used in both periods. Results: Snellen best-corrected visual acuity (BCVA) at baseline and after one year was 0.23 and 0.31 (p < 0.0001), respectively, for patients treated with ranibizumab and 0.25 and 0.33 (p < 0.0001) for patients treated with aflibercept, last observation carried forward. The share of patients (73%) still in treatment with ranibizumab at year 1 had a baseline BCVA of 0.26 but 0.40 at year 1 (p < 0.0001), and the patients (75%) still in treatment with aflibercept at year 1 had a baseline BCVA of 0.28 but 0.42 at year 1 (p < 0.0001). Proportional visual gains for both cohorts were comparable for one year (p = 0.14). The number of injections given within year 1 including first injection was 6.9 for ranibizumab and 5.9 for aflibercept (p < 0.0001). In patients continuing treatment through year 1, the number of injections was 8.0 for ranibizumab and 6.6 for aflibercept (p < 0.0001). The two cohorts had similar cause-of-discontinuation profiles. Conclusion: Treatment of nAMD at a single centre in two sequential cohorts yielded comparable BCVA outcomes with 15% fewer injections of aflibercept compared to ranibizumab.