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Worth changing? Clinical effects of switching treatment in neovascular age-related macular degeneration from intravitreal ranibizumab and aflibercept to bevacizumab in a region in southern Sweden
Hoglandssjukhuset, Sweden; Futurum, Sweden.
Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Pharmacology. Futurum, Sweden.
2019 (English)In: European Journal of Ophthalmology, ISSN 1120-6721, E-ISSN 1724-6016, article id UNSP 1120672119883602Article in journal (Refereed) Epub ahead of print
Abstract [en]

Purpose: To examine the clinical effects of switching intravitreal drug treatment from the approved vascular endothelial growth factor inhibitors, ranibizumab and aflibercept, to off label use of bevacizumab in patients with wet age-related macular degeneration. Methods: This retrospective study scrutinized medical records of patients with wet age-related macular degeneration who switched therapy to bevacizumab due to a policy decision. Best corrected visual acuity, central retinal thickness, and number of injections before and 1 year after the switch was compared. The non-inferiority margin of best corrected visual acuity was five Early Treatment Diabetic Retinopathy Study letters. Results: A switch from ranibizumab was evaluable in 93 eyes and from aflibercept in 19 eyes. Neither of the groups had a significant non-inferior visual acuity 16 month after the switch. Mean best corrected visual acuity in Early Treatment Diabetic Retinopathy Study letters was 63.8 (95% confidence interval: 61.3-66.4) before and 62.2 (95% confidence interval: 59.3-65.1) after in the ranibizumab group and 68.2 (95% confidence interval: 63.3-73.1) before and 67.7 (95% confidence interval: 62.8-72.6) after in the aflibercept group. Mean central retinal thickness in micrometers decreased from 254 (95% confidence interval: 247-261) to 250 (95% confidence interval: 225-275) in the ranibizumab group and from 265 (95% confidence interval: 255-276) to 262 (95% confidence interval: 251-273) in the aflibercept group. The treatment was changed again after the switch in 18% of the patients in the ranibizumab group and 19% in the aflibercept group and these subjects were excluded from the analyses. Conclusion: In patients with neovascular age-related macular degeneration, a switch from ranibizumab or aflibercept to bevacizumab seems possible without a significant decrease in visual acuity in most patients.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD , 2019. article id UNSP 1120672119883602
Keywords [en]
Age-related macular degeneration; retina; legal aspects of medical; surgical therapy; socioeconomics and education in medicine; ophthalmology; practice management; CME; health economics
National Category
Ophthalmology
Identifiers
URN: urn:nbn:se:liu:diva-161849DOI: 10.1177/1120672119883602ISI: 000492132900001PubMedID: 31642333OAI: oai:DiVA.org:liu-161849DiVA, id: diva2:1370882
Note

Funding Agencies|Futurum - Akademin for vard och halsa Region Jonkopings lan [FUTURUM-808791]

Available from: 2019-11-18 Created: 2019-11-18 Last updated: 2019-11-18

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