Research conducted at the Cantonal Hospital of Lucerne, Switzerland suggests that treatment of newly diagnosed AMD patients with either aflibercept or ranibizumab appear to provide equivalent results in terms of functional and morphologic outcomes and in terms of the number of injections required. The retrospective, comparative study of consecutive patients treated over a 12-month period at the hospital’s Eye Clinic indicated that, following correction for baseline differences between the aflibercept (11 eyes) and ranibizumab (16 eyes) groups, there was no divergence in visual acuity (−0.97 letters [95 %CI.−6.06-4.12)]; p= 0.709), and there was no significant difference in the reduction of central foveal thickness (−25.16μm, 95 % CI; (−78.01-27.68); p= 0.351) between the two groups 1 year after treatment initiation. In addition, the number of injection did not differ (0.04 (95 % CI; −0.16-0.09); p= 0.565).
While aflibercept is understood to have a higher binding affinity and a longer duration of action when compared to ranibizumab, it remains unclear how such a theoretical advantage might translate to clinical outcomes. The authors of the present study suggest that, in practice, clinicians use the same pro re nata (PRN) regimen with monthly check-ups for both drugs, even though the aflibercept VIEW trial found that fewer injections were required in the second year, compared to ranibizumab. Although other studies had also failed to find differences between the two drugs regarding therapeutic use there was little information on clinical outcomes.
According to the study, nine patients (11 eyes), with an average age of 75.0 years (SD 6.74), were treated with aflibercept and fifteen patients (16 eyes), with an average age of 77.6 years (SD 9.2), were treated with ranibizumab with the proportion of female patients being similar between the two groups. When baseline differences were corrected there appeared to be no difference in BCVA within 1 year of follow-up and there was also no significant difference in the reduction of central foveal thickness (CFT) between the two groups within 1 year as reported above. In short, the study indicated a similarity of outcomes for both therapies when treating patients for one-year. In addition, both anti-VEGF compounds appeared equivalent in terms of injection frequency and visual outcome. However, the authors did note a considerable difference in the baseline measurements of BCVA and CFT in both groups (visual acuity was better on average and CFT was significantly lower in the aflibercept group) indicating some manner of a “tacit algorithm” potentially at work in the decision making and selection process of clinicians. In addition, as the study was a retrospective non-randomised study, selection bias cannot be completely ruled out and a more rigorous comparative study, extending beyond the 1-year duration, would be required before any definitive conclusions could be drawn. While no competing interests were declared in relation to the study, one of the authors disclosed receipt of an unrestricted educational grant from Novartis.