Case 1: Managing Suboptimal Response in Bilateral nAMD: Transitioning From Biosimilars to High-Dose Aflibercept for Durable Drying

Opinion
Video

A panelist discusses how a woman aged 74 years with neovascular age-related macular degeneration (nAMD) showed improved disease control and vision in her right eye after switching from ranibizumab to a high-dose aflibercept (8 mg) treatment that successfully extended intervals to 10 weeks.

Clinical Brief: Aflibercept 8 mg for nAMD

Main Discussion Topics

  • Treatment Response and Switching Therapies: A woman aged 74 years with suboptimal control of nAMD in the right eye despite 17 injections of ranibizumab/biosimilar, whereas the left eye showed good control.
  • High-Dose Aflibercept Initiation: Decision to start aflibercept 8 mg for better disease control and potential treatment interval extension in both eyes.
  • Extended Treatment Intervals: Patient demonstrated improved disease control with aflibercept 8 mg, allowing successful extension from 6 weeks to 8 weeks and eventually 10 weeks between treatments.
  • Long-term Response Patterns: Vision improved over time with continued reduction in central subfield thickness, even with extended treatment intervals.

Key Points for Physicians

  • Patients may show improved disease control over time with extended treatment intervals of aflibercept 8 mg.
  • Residual edema or subretinal fluid does not necessarily require reducing treatment intervals if vision remains stable and no hemorrhage is present.
  • Treatment extension to 8 to 10 weeks was possible while maintaining disease control.
  • Consider patient preferences and treatment burden when selecting the treatment agent and intervals.

Notable Insights

  • Some physicians prefer using the same agent in both eyes, even with differential response.
  • Clinicians may have varying tolerance for subretinal vs intraretinal fluid.
  • No specific demographic or optical coherence tomography features reliably predicted superior response to particular agents.
  • Determining nonresponse vs lack of durability remains challenging, with some patients potentially requiring very frequent anti-VEGF suppression.

Clinical Significance

The case demonstrates that aflibercept 8 mg offers effective disease control for nAMD with the potential for extended treatment intervals, reducing treatment burden while maintaining visual outcomes.

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