Ranibizumab and Aflibercept Prompt Comparable Visual Gain in AMD

By David Douglas

January 31, 2019

NEW YORK (Reuters Health) - In patients with neovascular age-related macular degeneration (nAMD), aflibercept and ranibizumab achieve similar average visual acuity increases, according Australian researchers.

In a January 24 online paper in JAMA Ophthalmology, Dr. Mark C. Gillies of Sydney Hospital and colleagues report on a preplanned one-year interim analysis of the RIVAL randomized trial, which is comparing the two drugs in 281 treatment-naive eyes from 281 participants with active choroidal neovascularization secondary to nAMD and a visual acuity letter score of 23 or greater.

Patients received intravitreal injections of 0.5 mg of ranibizumab or 2.0 mg of aflibercept. Following three injections, they moved on to a treat and extend injection regimen. The primary end-point of the study - the mean change in area of macular atrophy from baseline to study completion at 24 months - is yet to be analyzed.

In this interim phase, the researchers examined the secondary end points of mean change in best corrected visual acuity (BCVA) and the number of injections from baseline to month 12 in 127 ranibizumab recipients and 121 aflibercept patients.

The baseline mean BCVA letter score was 65.3 in the ranibizumab arm and 65.1 in the aflibercept arm. At month 12 the corresponding values were 72.9 and 70.5 with the mean changes being 7.2 and 4.9. The mean number of injections for both agents was 9.7.

Thus, Dr. Gillies told Reuters Health by email, "we could find no significant differences in the outcomes of eyes treated with aflibercept or ranibizumab for neovascular (wet) age-related macular degeneration. They received the same number of injections on average using the treatment regimen that is most commonly used in real-world practice, 'treat and extend' with similar improvements in vision. Both drugs give excellent results for this condition if they are given adequately."

Dr. Gillies and colleagues conclude, "Further follow-up to two years may determine if advantages of one over the other can be identified."

Dr. Martin McKibbin of St James's University Hospital, Leeds, UK, co-author of an accompanying editorial, told Reuters Health by email that although these are secondary end-points, "the data are very interesting as they suggest that there is no meaningful difference in visual acuity outcomes and the number of injections when either ranibizumab or aflibercept are used in identical treat-and-extend regimes."

SOURCE: http://bit.ly/2RXDVpK and http://bit.ly/2RTsKhC

JAMA Ophthalmol 2019.