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    Switching treatments for wet AMD poses numerous complexities

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


    The 26 enrolled patients had subfoveal choroidal neovascularization secondary to exudative AMD, one or more injections of ranibizumab or bevacizumab within 3 months of enrollment for active exudative AMD, an ETDRS vision of 20/25 to 20/320, and presence of fluid by OCT or presence of a new hemorrhage by clinical exam.

    Patients received three upfront injections of aflibercept (Eylea, Regeneron) followed by Q2 month injections thereafter.

    Patients were re-treated if any of the following occurred 30 days since the last treatment:

    • Loss of 10 or more ETDRS letters from the best previous measurement,
    • A 75-µm increase in retinal thickness, and
    • The presence of new subretinal hemorrhage by clinical exam.

    Patients in the study had a mean of 9.62 injections before the study, with a range of 3 to 23 injections. The mean central retina thickness was 304.08 µm.

    At the end of the study, the average number of aflibercept injections was 9.6. There was a mean 9.4 letter visual gain and an overall reduction in central retina thickness.

    Dr. Singh concluded that it is challenging to interpret the results of switching studies, and that most of these studies are conducted because of the reasons he outlined.

    Although some rationales for these studies may not be valid in light of evaluation of clinical trial data, the studies can evaluate a patient population that may not be included within a clinical trial and may represent more real-life scenarios, he said.

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