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Sinawat S, Hemanak S, Chanthowong K, Sinawat S, Yospaiboon Y. Intravitreal Ziv-Aflibercept versus Bevacizumab for Naïve Central Retinal Vein Occlusion with Macular Edema: An Interim Analysis of a Randomized Non-Inferiority Trial. Clin Ophthalmol 2023; 17:2719-2728. [PMID: 37743891 PMCID: PMC10516305 DOI: 10.2147/opth.s428792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023] Open
Abstract
Purpose To compare the efficacy of intravitreal ziv-aflibercept (IVZ) and bevacizumab (IVB) injections for the treatment of macular edema secondary to central retinal vein occlusion. Methods Participants were randomly assigned 1:1 to receive 3 monthly IVZ (1.25 mg/0.05 mL) or IVB (1.25 mg/0.05 mL) followed by the pro-re-nata protocol for persistent or recurrent macular edema. The primary outcomes were best-corrected visual acuity and central subfield thickness. An interim analysis was planned when half of the participants completed the follow-up. Results Twenty-four participants were recruited. At 6 months, mean best-corrected visual acuity in the IVB and IVZ groups improved from 1.23 ± 0.64 to 0.76 ± 0.56 logMAR (p = 0.003) and from 1.13 ± 0.59 to 0.53 ± 0.26 logMAR (p = 0.003), respectively. The percentage of visual improvement and reduction in central subfield thickness in the IVZ group were insignificantly better than those in the IVB group (44.41 ± 26.72 vs 39.64 ± 24.22%; p = 0.65) and (51.94 ± 20.35 vs 45.78 ± 24.71%; p = 0.51), respectively. Although the mean number of injections was lower in the IVZ group (4.55 ± 1.29 vs 4.82 ±1.33), the difference was not statistically significant (p = 0.68). No ocular or systemic adverse events were observed. Conclusion The interim analysis demonstrated that the visual and anatomical results of IVZ were insignificantly better than those of IVB at 6 months of follow-up. The results also showed that IVZ was non-inferior to IVB for anatomical improvement but inconclusive for visual improvement. Clinical Trial Registration (identifier: TCTR20191205008).
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Affiliation(s)
- Suthasinee Sinawat
- Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- KKU Eye Center, Khon Kaen University, Khon Kaen, Thailand
| | - Suthasinee Hemanak
- Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kwanchanok Chanthowong
- Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Supat Sinawat
- Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Yosanan Yospaiboon
- Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- KKU Eye Center, Khon Kaen University, Khon Kaen, Thailand
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Electrophysiological evaluation and 18-month follow-up of two regimens with aflibercept for neovascular age-related macular degeneration. Doc Ophthalmol 2022; 144:99-115. [PMID: 35218455 PMCID: PMC9033741 DOI: 10.1007/s10633-021-09863-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/08/2021] [Indexed: 11/22/2022]
Abstract
Purpose To compare two aflibercept treatment regimens and the electrophysiological outcome concerning cone and rod function in age-related macular degeneration (nAMD) over 18 months. Methods 41 patients with treatment-naïve nAMD were randomized 1:1 to either arm 1 or 2. Arm 1 received three consecutive monthly aflibercept injections, followed by bimonthly treatment until week 52. Thereafter, a treat-and-extend (TAE) regimen was applied. Arm 2 was treated according to a TAE protocol throughout the 18-month follow-up. We assessed visual acuity (VA), central retinal thickness (CRT), injection rate and interval, and evaluated cone and rod function with full-field and multifocal electroretinography (ffERG, mERG). Results There were no statistically significant differences in mean baseline VA, lesion type, age, gender, or symptom duration between the two arms. During the 18-month follow-up, mean VA improved in arm 1 (n = 19) from 63.5 ± 10.5 to 69.1 ± 9.2 letters; p = 0.098; and in arm 2 (n = 20) from 66.8 ± 13.6 to 73.9 ± 9.0 letters; p = .002. In both arms, mean CRT was significantly reduced; p < 0.000. At month 18, we found no significant difference in the number of injections or injection intervals between groups. Arm 1 had received 11.3 ± 1.7 injections vs. 10.9 ± 2.0 in arm 2. The mean injection interval was 9.2 ± 3.4 weeks vs. 9.5 ± 3.1, with 52% (n = 10) on the maximum 12-week interval in arm 1, and 50% (n = 10) in arm 2. The combined rod-cone a-wave amplitude significantly decreased over time; p = 0.043. The isolated rod b-wave amplitude showed a statistically significant decline; p = 0.026. The overall mERG amplitude and implicit time remained unchanged over time; p = 0.878 vs. p = 0.922. The central ring 1 mERG amplitude improved; p = 0.041, with an unaffected implicit time. Conclusions After 18 months, both treatments arms have received a similar number of injections at comparable intervals. Electrophysiological evaluation shows no signs of toxicity concerning cone function. But ffERGs for the combined and isolated rod response have declined, possibly reflecting either toxic effects of the drug to rods or the natural course of the disease itself.
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D'Souza HS, Kapoor KG, Wagner AL. Ziv-aflibercept for Better Regulating Neovascular Age-Related Macular Degeneration (ZEBRA): A Prospective, Randomized Trial. Semin Ophthalmol 2021; 36:28-34. [PMID: 33577373 DOI: 10.1080/08820538.2021.1884269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study is to determine if ziv-aflibercept is a safe and effective maintenance drug for nAMD. STUDY DESIGN AND METHODS This is a randomized, prospective, single-blinded trial. Inclusion criteria were active nAMD, prior anti-VEGF treatment, and BCVA ≤20/200. The treatment group received ziv-aflibercept. The control group continued their existing anti-VEGF regimen. The main outcome measures were BCVA, CFT, and safety. RESULTS Mean baseline BCVA was 1.58 ± 0.44 logMAR and 1.71 ± 0.39 logMAR in the control (n = 27) and treatment (n = 29) groups, respectively. After 24 months, the mean change in BCVA was 0.11 in the control group (equivalent to a loss of 5 ETDRS letters) and 0.01 logMAR in the treatment group (p = .48). Baseline CFT was 257 ± 33 μm and 247 ± 30 μm in the control and treatment groups, respectively, and after 24 months mean change in CFT was 26 μm and -5 μm (p = .24). There were no ocular or systemic adverse events during the study. CONCLUSION Ziv-aflibercept is a safe and effective as a maintenance drug for patients with nAMD. It may represent a cost-effective alternative to aflibercept and second-line therapy for eye resistant bevacizumab or ranibizumab.
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Affiliation(s)
- Haley S D'Souza
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Kapil G Kapoor
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, VA, USA.,Wagner and Kapoor Retina Institute, Virginia Beach, VA, USA
| | - Alan L Wagner
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, VA, USA.,Wagner and Kapoor Retina Institute, Virginia Beach, VA, USA
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Mansour AM, Stewart MW, Farah ME, Mansour HA, Chhablani J. Ziv-aflibercept: A cost-effective, off-label, highly potent antagonist of vascular endothelial growth factor. Acta Ophthalmol 2020; 98:e540-e548. [PMID: 31863550 DOI: 10.1111/aos.14328] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 11/13/2019] [Indexed: 01/14/2023]
Abstract
Ziv-aflibercept (Zaltrap® ), a recombinant fusion protein that binds diffusible vascular endothelial growth factor (VEGF), is approved for the treatment of metastatic colorectal carcinoma. Its molecular structure is the same as aflibercept (Eylea® ), thus making it an attractive option for the off-label treatment of chorioretinal vascular conditions. Ziv-aflibercept is distributed in 4 and 8 ml vials for intravenous use, and its cost after compounding is similar to bevacizumab. Studies with retinal pigment epithelium cytotoxicity, animal histologic sections and electroretinography have demonstrated its safety, and mathematical modelling combined with over four dozen clinical publications from different ophthalmic centres throughout the world attest to its efficacy. No appreciable differences in visual or anatomic outcomes between 1.25 mg (0.05 ml) and 2.5 mg (1.0 ml) doses have been noted. The long duration of action combined with the low cost make ziv-aflibercept an attractive anti-VEGF treatment option, especially in low- and middle-income countries where its popularity is increasing.
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Affiliation(s)
- Ahmad M Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon.,Department of Ophthalmology, Rafik Hariri University Hospital, Beirut, Lebanon
| | | | - Michel E Farah
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Hana A Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon.,Department of Ophthalmology, Rafik Hariri University Hospital, Beirut, Lebanon
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
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Cáceres-Del-Carpio J, Moustafa MT, Toledo-Corral J, Hamid MA, Atilano SR, Schneider K, Fukuhara PS, Costa RD, Norman JL, Malik D, Chwa M, Boyer DS, Limb GA, Kenney MC, Kuppermann BD. In vitro response and gene expression of human retinal Müller cells treated with different anti-VEGF drugs. Exp Eye Res 2020; 191:107903. [PMID: 31904361 PMCID: PMC7058176 DOI: 10.1016/j.exer.2019.107903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/18/2019] [Accepted: 12/23/2019] [Indexed: 12/14/2022]
Affiliation(s)
| | - M Tarek Moustafa
- Gavin Herbert Eye Institute, University of California, Irvine, CA, USA
| | | | - Mohamed A Hamid
- Gavin Herbert Eye Institute, University of California, Irvine, CA, USA
| | - Shari R Atilano
- Gavin Herbert Eye Institute, University of California, Irvine, CA, USA
| | - Kevin Schneider
- Gavin Herbert Eye Institute, University of California, Irvine, CA, USA
| | - Paula S Fukuhara
- Gavin Herbert Eye Institute, University of California, Irvine, CA, USA
| | | | - J Lucas Norman
- Gavin Herbert Eye Institute, University of California, Irvine, CA, USA
| | - Deepika Malik
- Gavin Herbert Eye Institute, University of California, Irvine, CA, USA
| | - Marilyn Chwa
- Gavin Herbert Eye Institute, University of California, Irvine, CA, USA
| | - David S Boyer
- Retina-Vitreous Associates Medical Group, Los Angeles, CA, USA
| | - G Astrid Limb
- Division of Ocular Biology and Therapeutics, UCL Institute of Ophthalmology, London, UK
| | - M Cristina Kenney
- Gavin Herbert Eye Institute, University of California, Irvine, CA, USA; Department of Pathology and Laboratory Medicine, University of California, Irvine, CA, USA.
| | - Baruch D Kuppermann
- Gavin Herbert Eye Institute, University of California, Irvine, CA, USA; Department of Biomedical Engineering, University of California, Irvine, USA
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Braimah IZ, Kenu E, Amissah-Arthur KN, Akafo S, Kwarteng KO, Amoaku WM. Safety of intravitreal ziv-aflibercept in choroido-retinal vascular diseases: A randomised double-blind intervention study. PLoS One 2019; 14:e0223944. [PMID: 31647843 PMCID: PMC6812750 DOI: 10.1371/journal.pone.0223944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 09/29/2019] [Indexed: 11/18/2022] Open
Abstract
AIM To evaluate the safety of 1.25mg and 2mg intravitreal ziv-aflibercept (IVZ) in Ghanaian eyes with choroido-retinal vascular diseases. DESIGN Prospective, randomised, double blind, interventional study. METHODS Twenty patients with centre involving macular oedema in diabetic retinopathy, retinal vein occlusion, and neovascular age-related macular degeneration were assigned to 2 groups receiving 3 doses of 1.25mg/0.05ml (group 1) and 2mg/0.08ml IVZ (Group 2) at 4 weekly intervals. Safety data was collected after 30 minutes, 1 and 7 days, and 4, 8 and 12 weeks after injection. Changes in continuous variables were compared using paired t-test and categorical variables were compared using chi-square test of proportions. Repeated-Measures ANOVA with nesting test was used to compare variations in continuous variables by IVZ dose over time. Primary outcome measures were ocular and systemic adverse events at 4 weeks. RESULTS Eleven females and nine males, with mean age of 63.2± 7.3 years were included. Ocular adverse events included subconjunctival haemorrhage in 1 eye, intraocular pressure (IOP) >21mmHg at 30 minutes in 6 eyes and mild pain in 3 eyes at 1-day. There was no significant difference in IOP rise between the 2 groups at 30 minutes (p = 0.21). No other ocular or systemic adverse events were observed. There was significant improvement in the best corrected visual acuity (LogMAR) from 0.95±0.6 to 0.6±0.4 (p<0.01) and 0.47±0.3 (p<0.01), reduction in central subfield foveal thickness from 405.9±140 um at baseline to 255.6±75 um (p<0.01) and 238±88 um (p<0.01) at 4 and 12 weeks respectively, although no difference was observed between the 2 groups (p = 0.34). CONCLUSION IVZ at 1.25mg and 2mg had similar safety profiles, and did not have any major unexpected adverse events. Further studies with larger cohorts are required to confirm efficacy.
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Affiliation(s)
- Imoro Zeba Braimah
- Department of Surgery (Eye), School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
- Eye Centre, Korle- Bu Teaching Hospital, Korle- Bu, Accra, Ghana
| | - Ernest Kenu
- Department of Epidemiology, School of Public Health, University of Ghana, Accra, Ghana
| | - Kwesi N. Amissah-Arthur
- Department of Surgery (Eye), School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
- Eye Centre, Korle- Bu Teaching Hospital, Korle- Bu, Accra, Ghana
| | - Stephen Akafo
- Department of Surgery (Eye), School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
- Eye Centre, Korle- Bu Teaching Hospital, Korle- Bu, Accra, Ghana
| | | | - Winfried M. Amoaku
- Academic Ophthalmology, DCN, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, England, United Kingdom
- * E-mail:
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Barmas-Alamdari D, D’Souza HS, Kapoor KG, Wagner AL. Intravitreal Ziv-Aflibercept: A Comprehensive Review. Semin Ophthalmol 2019; 34:420-435. [DOI: 10.1080/08820538.2019.1641526] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
| | - Haley S. D’Souza
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, Virginia, USA
- Ophthalmology Research, Wagner Macula and Retina Center, Virginia Beach, Virginia, USA
| | - Kapil G. Kapoor
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, Virginia, USA
- Ophthalmology Research, Wagner Macula and Retina Center, Virginia Beach, Virginia, USA
| | - Alan L. Wagner
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, Virginia, USA
- Ophthalmology Research, Wagner Macula and Retina Center, Virginia Beach, Virginia, USA
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Yuan J. Role of inflammatory factors in the effects of aflibercept or ranibizumab treatment for alleviating wet age-associated macular degeneration. Exp Ther Med 2019; 17:4249-4258. [PMID: 30988797 DOI: 10.3892/etm.2019.7427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 09/13/2018] [Indexed: 12/12/2022] Open
Abstract
Aflibercept and ranibizumab are novel drugs for effectively treating wet age-associated macular degeneration (AMD). In the present study, the effect of aflibercept and ranibizumab on wet AMD was compared. A total of 80 AMD patients were intravitreously treated with aflibercept (2.0 mg/dose, 40 participants) or ranibizumab (0.3 mg/dose, 40 participants). The mean visual acuity and central subfield thickness (CTS) were determined at baseline and each follow-up visit (every 4 weeks). ELISA was used to detect the expression of transforming growth factor-β1 (TGF-β1), monocyte chemoattractant protein 1 (MCP-1) and interleukin 6 (IL-6). The primary outcome was the mean change in visual acuity letter score (VAS) and CTS at 1 year. The VAS was markedly improved by 13.1 in the aflibercept group and by 11.0 in the ranibizumab group. In a subgroup of patients with an initial VAS of <69, the mean improvement in the VAS was 17.7 in the aflibercept group and 13.2 in the ranibizumab group (P<0.01). The mean CTS was markedly decreased by 141 in the aflibercept group and by 134 in the ranibizumab group. In the subgroup of patients with an initial VAS of <69, the mean CTS was decreased by 171 in the aflibercept group and by 154 in the ranibizumab group (P<0.01). However, the change of VAS and CTS was similar between the ranibizumab and aflibercept groups when the initial VAS was ≥69. No significant differences in serious adverse events were identified between the aflibercept and ranibizumab groups. The levels of TGF-β1, IL-6 and MCP-1 were decreased by the aflibercept and ranibizumab treatments. The decrease in the levels of the inflammatory factors was more obvious in patients with an initial VAS of <69 in comparison with that in patients with an initial VAS of ≥69. Negative correlations between the levels of TGF-β1, MCP-1 and IL-6 and the mean change of VAS when patients were treated with aflibercept or ranibizumab were identified among all ages. Positive correlations between the levels of TGF-β1, MCP-1 and IL-6 and the mean change of CTS were observed when the initial VAS of the patients was <69. In conclusion, the efficacy of aflibercept in treating patients with AMD was better than that of ranibizumab when the initial VAS of the patients was <69. The inhibition of inflammatory factors may be a secondary effect of aflibercept and ranibizumab treatment. The present study provides a useful reference for the clinical treatment of wet AMD (Chinese Clinical Trial Registry no. ChiCTR1800017782).
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Affiliation(s)
- Jianshu Yuan
- Ophthalmology Department, Ningbo Eye Hospital, Ningbo, Zhejiang 315040, P.R. China
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Papadopoulos Z. Aflibercept: A review of its effect on the treatment of exudative age-related macular degeneration. Eur J Ophthalmol 2019; 29:368-378. [PMID: 30813810 DOI: 10.1177/1120672119832432] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Considerable improvement has been achieved in the way in which exudative age-related macular degeneration is conventionally treated and in the associated visual outcomes and prognosis, thanks to the agents with effects against vascular endothelial growth factor (anti-VEGF). By comparison to earlier treatment approaches that involved the use of lasers, the anti-VEGF agents have made it possible to accomplish more positive visual and anatomical outcomes in cases of exudative age-related macular degeneration. Indeed, owing to their positive effects, anti-VEGF agents have quickly come to be considered the gold standard for the treatment of wet age-related macular degeneration. Aflibercept, the most recently approved intravitreally administered anti-VEGF, seems to mark another milestone in the treatment of wet age-related macular degeneration. This anti-VEGF agent presents a series of singular pharmacodynamic and pharmacokinetic attributes that provide it a number of biological benefits in relation to the treatment of choroidal neovascularization compared to other agents. These attributes include high level of affinity for the VEGF-A factor, an intravitreal half-life of great length, as well as the ability to serve as an antagonist for other growth factors besides VEGF. The impact of Aflibercept on the manner in which exudative age-related macular degeneration is managed was demonstrated by thoroughly reviewing the related literature. The present review article highlights the pharmacology, pharmacokinetics, safety and effectiveness of this anti-VEGF agent as well as the landmark clinical studies that have been carried out to establish this drug as a gold standard in the therapy of neovascular age-related macular degeneration. In addition, studies regarding the outcomes and effectiveness of the various dosage regimens, either as monotherapy or in combination with other agents, are also reviewed.
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Affiliation(s)
- Zois Papadopoulos
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
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Singh SR, Stewart MW, Chattannavar G, Ashraf M, Souka A, ElDardeery M, Wadhwa N, Sarvaiya C, Mansour AM, Marashi A, Ramchandani S, Braimah IZ, Jabbarpoor Bonyadi MH, Ramezani A, Soheilian M, de Oliveira Dias JR, de Andrade GC, Maia A, Rodrigues EB, Farah ME, Banker A, Chhablani J. Safety of 5914 intravitreal ziv-aflibercept injections. Br J Ophthalmol 2018; 103:805-810. [DOI: 10.1136/bjophthalmol-2018-312453] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 06/11/2018] [Accepted: 07/02/2018] [Indexed: 11/03/2022]
Abstract
PurposeTo analyse the pooled safety data of intravitreal ziv-aflibercept (IVZ) therapy for various retinal conditions.MethodsThis was a retrospective, observational study which included patients from 14 participating centres who received IVZ. The medical records of patients who received IVZ from March 2015 through October 2017 were evaluated. Patient demographics and ocular details were compiled. Ocular and systemic adverse events that occurred within 1 month of IVZ injections were recorded and defined as either procedure-related or drug-related.ResultsA total of 1704 eyes of 1562 patients received 5914 IVZ injections (mean±SD: 3.73±3.94) during a period of 2.5 years. The age of patients was 60.6±12.8 years (mean±SD) and included diverse chorioretinal pathologies. Both ocular (one case of endophthalmitis, three cases of intraocular inflammation, and one case each of conjunctival thinning/necrosis and scleral nodule) and systemic adverse events (two cases of myocardial infarction, one case of stroke and two deaths) were infrequent.ConclusionThis constitutes the largest pooled safety report on IVZ use and includes patients from 14 centres distributed across the globe. It shows that IVZ has an acceptable ocular and systemic safety profile with incidences of adverse events similar to those of other vascular endothelial growth factor inhibitory drugs. The analysis supports the continued use of IVZ in various retinal disorders.
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Mansour AM, Charbaji A, Farah ME, Mansour HA, Chhablani J. Long-term outcome of treat and extend intravitreal ziv-aflibercept therapy. Br J Ophthalmol 2018; 103:938-941. [DOI: 10.1136/bjophthalmol-2018-312593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 06/25/2018] [Accepted: 07/19/2018] [Indexed: 11/04/2022]
Abstract
AimTo assess the 30-month outcome of treat and extend (TAE) intravitreal ziv-aflibercept therapy in eyes with macular diseases.MethodsIn this prospective study, consecutive subjects received intravitreal 0.05 mL ziv-aflibercept (1.25 mg) injections for various macular diseases. Outcome measures were best-corrected visual acuity (BCVA) (logarithm of the minimum angle of resolution) and central macular thickness (CMT) on spectral domain optical coherence tomography. Paired comparison was done using Wilcoxon signed-rank test calculator.ResultsFifty-three eyes of 48 subjects (33 naïve eyes) received intravitreal ziv-aflibercept and were followed between 12 and 30 months following TAE included neovascular age-related macular degeneration (nAMD) (35 eyes) and diabetic macular oedema (DMO) (18 eyes). In eyes with nAMD, CMT decreased by 107.8 µm at the 30-month follow-up (p=0.012) with BCVA gain of 0.52 (p=0.001). In eyes with DMO, CMT decreased by 224.3 µm at the 30-month follow-up (p=0.027) with BCVA gain of 0.46 (p=0.042). Combining all disease categories, the mean number of injections was 9.2 at month 12, 2.5 between 12 and 18 months, 1.6 between 18 and 24 months and 1.0 between 24 and 30 months.ConclusionsUsing TAE regimen, intravitreal ziv-aflibercept appeared efficacious at managing retinal disease through month 30 using the TAE regimen.
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