Treatment results switching from aflibercept to bevacizumab in wet age-related macular degeneration

AIM: To examine effects of switching intravitreal aflibercept to bevacizumab in neovascular age-related macular degeneration (nAMD). METHODS: Data from patients treated for nAMD with anti-vascular endothelial growth factor (VEGF) injections at Örebro University Hospital between January 2014 and June 2020, were extracted from the Swedish macular register (SMR). A total of 230 eyes were included in the study: 116 in the study/bevacizumab switch group and 114 in the control/aflibercept group. Central retinal thickness (CRT) was measured at baseline and after 2y. Primary outcome was mean change in best corrected visual acuity (BCVA) between baseline and 2y. Secondary outcome variables included proportion of patients with a clinically significant change in BCVA [increase or decrease of ≥15 Early Treatment Diabetic Retinopathy Study (ETDRS) letters], mean change in CRT, number of anti-VEGF injections, number of visits assessing disease activity and number of visits with active disease. RESULTS: The mean difference in BCVA between baseline and 2y was 1.13±14.47 ETDRS letters in the bevacizumab switch group and 1.81±13.01 ETDRS letters in the aflibercept group. The lower bound of the 95% confidence interval of the difference in BCVA was -4.25, indicating non-inferiority within a 5 ETDRS letter limit. No significant differences in mean change of CRT between baseline and 2y were detected (study -185.9±167.0 versus control -149.4±193.1 µm, P=0.127). The distribution of clinically significant improvement (P=0.598) or worsening (P=0.508) of BCVA during follow-up did not show statistically significant differences between groups. The number of anti-VEGF injections administered (study 12.76±2.20 versus control 13.10±4.20, P=0.442), the number of visits assessing disease activity (P=0.301), and the number of visits with active disease (P=0.065) did not show differences between subjects receiving bevacizumab and aflibercept treatment. No significant differences were detected in baseline characteristics between the study and control groups, including age, BCVA, CRT, neovascular membrane type or location, duration of symptoms or prior cataract surgery. CONCLUSION: Switching to off-label bevacizumab in patients responding to initial aflibercept treatment is non-inferior to continued aflibercept treatment with respect to change in visual acuity at 2y. Switching anti-VEGF from aflibercept to bevacizumab may be a viable option in clinical settings with limited resources.