Outcomes after switching eyes that were stable on aflibercept to ranibizumab versus continuing aflibercept in neovascular age-related macular degeneration

Purpose To describe outcomes of neovascular age-related macular degeneration (nAMD) eyes that were stable on aflibercept but switched to ranibizumab compared to eyes maintained on aflibercept over the same period. Methods In this retrospective cohort study, eyes switched from aflibercept to ranibizumab due to intraocular inflammation (IOI) concerns with aflibercept were identified. Data was gathered from 3 visits pre-switch, switch visit (Sw), and 3 visits post-switch (P1, P2, P3). Similar data was gathered on eyes eligible to switch but continued on aflibercept with the middle visit considered the “presumed switch.” Outcome measures included visual acuity (VA) and central foveal thickness (CFT). Results A total of 142 eyes were analyzed with 71 in each of the switch and aflibercept groups. In the switch group, mean CFT increased from 165.7 µm at Sw to 184.7 µm at P1 ( p = 0.009), 180.9 µm at P2 ( p = 0.007), and 183.3 µm at P3 ( p = 0.004). VA changed from logMAR 0.43 (20/54) at Sw to 0.49 (20/61) at P1 ( p = 0.02), 0.54 (20/69) at P2 ( p = 0.008), and 0.53 (20/68) at P3 ( p = 0.04). In the aflibercept group, no significant change in CFT was found over the same period. VA changed from logMAR 0.56 (20/72) at the “presumed switch” to 0.58 (20/76) at P1 ( p = 0.085), 0.62 (20/83) at P2 ( p = 0.001), and 0.59 (20/77) at P3 ( p = 0.14). Conclusions nAMD eyes that were stable or improving on aflibercept but were switched to ranibizumab worsened, while those in a comparable group maintained on aflibercept remained fairly stable, suggesting a potential efficacy difference between the two drugs.