RÉSUMÉ
BACKGROUND/AIMS: Prospective data on switching anti-vascular endothelial growth factors in patients with neovascular age-related macular degeneration (nAMD) who have previously shown no/partial response are limited. This prospective study assessed the effect of switching from aflibercept to ranibizumab on anatomical and functional outcomes in patients with persistent/recurrent disease activity. METHODS: SAFARI (NCT02161575) was a 6-month, prospective, single-arm study conducted in the UK and Germany. Patients, meeting strict eligibility criteria for one of two subgroups (primary treatment failure or suboptimal treatment response), received 3 monthly intravitreal ranibizumab injections (0.5 mg). Thereafter, ranibizumab was administered pro re nata at monthly visits. The primary endpoint was change from baseline (CfB) to day 90 in central subfield retinal thickness (CSRT). Best-corrected visual acuity (BCVA) and retinal morphology parameters were assessed. RESULTS: One hundred patients were enrolled (primary treatment failure, 1; suboptimal treatment response, 99). In the overall population, there was a significant CfB in median CSRT of -30.75 µm (95% CI -59.50,-20.50; p<0.0001) to day 90. Improvements were also observed in other quantitative and qualitative optical coherence tomography parameters. In Early Treatment Diabetic Retinopathy Study letters assessed by category, 55% and 59% of patients gained 0-≥15 letters versus baseline at day 90 and day 180, respectively. However, mean improvements in BCVA (CfB) to each time point were small (≤2 letters). No new safety signals were identified. CONCLUSION: Switching from aflibercept to ranibizumab led to a significant improvement in CSRT, with ~60% experiencing stabilised/improved BCVA. Therefore, patients with nAMD who have shown a suboptimal response to aflibercept may benefit from switching to ranibizumab.
Sujet(s)
Inhibiteurs de l'angiogenèse/usage thérapeutique , Néovascularisation choroïdienne/traitement médicamenteux , Substitution de médicament , Ranibizumab/usage thérapeutique , Récepteurs aux facteurs de croissance endothéliale vasculaire/usage thérapeutique , Protéines de fusion recombinantes/usage thérapeutique , Dégénérescence maculaire humide/traitement médicamenteux , Sujet âgé , Sujet âgé de 80 ans ou plus , Néovascularisation choroïdienne/physiopathologie , Femelle , Angiographie fluorescéinique , Études de suivi , Allemagne , Humains , Injections intravitréennes , Mâle , Adulte d'âge moyen , Études prospectives , Rétine/anatomopathologie , Méthode en simple aveugle , Royaume-Uni , Facteur de croissance endothéliale vasculaire de type A/antagonistes et inhibiteurs , Acuité visuelle/physiologie , Dégénérescence maculaire humide/physiopathologieRÉSUMÉ
A patient with a 10-year history of Crohn's disease presented to our ophthalmology service with symptoms of acute anterior uveitis. Previous episodes had been treated successfully with topical steroids.However, on this occasion after treatment with topical steroids, the patient developed macular oedema with concurrent optic neuritis in the affected eye.Furthermore, optic neuritis persisted despite oral steroid treatment contrary to expectations based on current literature. After 6 months of treatment, optic disc oedema had markedly improved but was replaced by sectoral disc pallor.