Continuous aflibercept injections yield better outcomes in neovascular AMD

Continuous treatment with aflibercept leads to better visual outcomes in the long run among patients with neovascular age-related macular degeneration (nAMD), reports a new study.

The researchers retrospectively assessed 512 eyes from 468 treatment-naïve nAMD patients (mean age, 79.5±8.5 years; 54 percent female) who had started receiving aflibercept injections 5 years prior to study index. Data on visual acuity (VA) expressed as Early Diabetic Retinopathy Study (ETDRS) letters were collected from patient records, as were the patients’ injection records.

At baseline, mean VA for the study eyes was 58.3±15.4 letters, which increased gradually over the first 3 years of treatment, reaching a peak value of 60.5±19.5 letters. Thereafter, VA dropped, eventually reaching a value lower than baseline by the end of the 5-year observation period (55.0±24.0 letters).

The number of injections received decreased gradually over time. Of the 512 study eyes, one received ≤3 injections in the first year. This proportion grew to 23.7 percent, 39.1 percent, 45.9 percent, and 53.6 percent by year 2, 3, 4, and 5, respectively. The percentage of eyes that received ≥5 injections per year dropped from 60.0 percent at year 2 to 36.4 percent at year 5.

The Kruskal-Wallis and Dunnes tests were performed to assess the correlation between injection frequency and final VA. Eyes with good final VA (≥70 letters) tended to have received more injections as opposed to eyes with final VA ≤37 letters.

Increasing aflibercept frequency led to significantly better outcomes, such that each additional injection yielded a 0.6-letter gain in VA (p<0.001). Adjusting for sex and age did not alter the principal findings. Patients who received ≥20 injections overall had final VA that was 8.04 letters better than comparators with <20 injections (p=0.001).