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    Switching treatments for wet AMD poses numerous complexities

    Results from various studies remain difficult to interpret; more follow up needed


    Regarding tachyphylaxis, Dr. Singh cited a 2012 study in the British Journal of Ophthalmology that found switching between anti-vascular endothelial growth factor (VEGF) therapies—specifically, ranibizumab (Lucentis, Genentech) and bevacizumab (Avastin, Genentech) switched multiple times—appeared to be helpful.1

    He also mentioned the SEVEN-UP Study, which had 7 years of follow up and included 65 patients from the ANCHOR, MARINA, and HORIZON trials.2 In that study, there was initial improvement but a subsequent mean visual decline of almost 8.6 letters from baseline.

    “Is this just the treatment they were assigned to or tachyphylaxis over that course of treatment?” Dr. Singh said.

    When considering a switch because clinical trial data lack real-life application, Dr. Singh said that retina specialists most often choose a treat-and-extend approach even though there is a lack of randomized trials that support the efficacy of this. Most specialists choose monthly dosing in a minority of cases.

    “These trends reflect the inability to adopt monthly dosing,” he said.

    The idea of switching therapies to reduce the frequency of dosing is the “holy grail—what we all hope for our patients,” Dr. Singh said.

    Some research points to a value of this approach, he added.

    ASSESS Study

    These various considerations led Dr. Singh and fellow investigators to conduct the ASSESS Study—short for “A Single Arm, Investigator Initiated Observational Study of the Efficacy, Safety, and Tolerability of Intravitreal Aflibercept Injection in Subjects with Exudative Age Related Macular Degeneration Previously Treated with Ranibizumab or Bevacizumab.”

    NEXT: Conclusion

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