Real-world visual acuity outcomes between ranibizumab and aflibercept in treatment of neovascular AMD in a large US data set

Purpose To examine 12-month real-world visual acuity outcomes and treatment patterns in neovascular age-related macular degeneration (nAMD) eyes, including those with pigment epithelial detachment (PED), receiving ranibizumab or aflibercept. Patients and methods Electronic medical records were used to identify ranibizumab or aflibercept-treated nAMD eyes with 12 months follow-up from first prescription. The primary objective was to compare mean change in visual acuity (VA) between index and month 12, in eyes treated with ranibizumab and aflibercept to assess the non-inferiority of ranibizumab vs aflibercept using a -5 letter non-inferiority margin. The number of injections and non-injection visits during follow-up were key secondary objectives. Results A total of 3350 ranibizumab and 4300 aflibercept treatment-naive eyes were included. At month 12, mean change from index in VA letter score was -0.30 for ranibizumab and -0.19 for aflibercept (P = 0.81). The adjusted difference of mean change was -0.14 (-0.79 to 0.51) (P = 0.67) (generalized estimating equations method) confirming the non-inferiority of ranibizumab. Eyes received a similar number of injections during follow-up. The mean (+/- SD) number of ranibizumab and aflibercept injections were 6.70 (+/- 2.54) and 7.00 (+/- 2.40), respectively (P < 0.0001). In PED eyes, the mean (+/- SD) change between baseline to month 12 was 1.25 (+/- 11.3) for ranibizumab and -0.39 (+/- 13.3) for aflibercept (adjusted between-group difference 1.80 (-0.71 to 4.30; P = 0.16)) achieved with a mean (+/- SD) 7.85 (+/- 2.68) ranibizumab and 7.47 (+/- 2.45) aflibercept injections, (P = 0.11). Conclusions Ranibizumab and aflibercept treatment yielded comparable VA outcomes in nAMD eyes, including those with PED, with similar treatment patterns over 12 months in real-world clinical practice.