Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2026
Switching to aflibercept 8 mg in neovascular age-related macular degeneration: real-world outcomes according to switch indication.
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Veritti Daniele, Sarao Valentina, Lupidi Marco, Viggiano Pasquale, Lombardo Marco, Parravano Mariacristina, Savastano Maria Cristina, Boscia Giacomo, Borrelli Enrico, Toto Lisa, Martin Asia Amelia, Termite Alba Chiara, Ribezzi Giulia, Nacciarriti Enrico, Fossataro Claudia, Gisotti Eleni Nikolopoulou, Neri Giovanni, Persavalli Cesare, Boscia Francesco, Mariotti Cesare, Mastropasqua Rodolfo, Reibaldi Michele, Ricci Federico, Rizzo Stanislao, Savastano Alfonso, Varano Monica, Lanzetta Paolo
Аннотация
PURPOSE: To evaluate visual and anatomical outcomes after switching to aflibercept 8 mg in eyes with neovascular age-related macular degeneration (nAMD), and to assess outcomes according to the clinical indication for switching.
METHODS: Multicentre retrospective observational study including 300 eyes with nAMD previously treated with anti-vascular endothelial growth factor therapy and switched to aflibercept 8 mg for non-response (n:74, 24.7%), suboptimal response (n:159, 53.0%), or durability-driven reasons (n:67, 22.3%). Longitudinal data from the 6 months preceding the switch and post-switch visits at 3 and 6 months were analyzed. The primary outcome was change in best-corrected visual acuity (BCVA, ETDRS letters) from the switch visit to the 3-month post-switch visit. Secondary outcomes included changes in central subfield thickness (CST) and retinal fluid status.
RESULTS: During the pre-switch period, mean BCVA declined by - 1.9 ± 8.2 letters and CST increased. At 3 months after switching, BCVA improved by + 2.0 ± 9.2 letters (95% CI, + 0.8 to + 3.2; p < 0.01), with greater gains in eyes switched for non-response (+ 2.8 ± 12.6 letters). Mean CST decreased by - 45.3 ± 79.8 µm (95% CI, - 55.4 to - 35.2; p < 0.001), with corresponding reductions in retinal fluid. Anatomical improvements were more pronounced in eyes switched for non-response, whereas more modest but consistent changes were observed in suboptimal and durability-driven groups. Visual and anatomical outcomes were maintained at 6 months.
CONCLUSIONS: In previously treated nAMD eyes, switching to aflibercept 8 mg was associated with reversal of pre-switch anatomical worsening, reduction in retinal fluid, and modest visual gains. Greater responses were observed in eyes with inadequate pre-switch disease control, supporting its role as a treatment escalation strategy in clinical practice.
METHODS: Multicentre retrospective observational study including 300 eyes with nAMD previously treated with anti-vascular endothelial growth factor therapy and switched to aflibercept 8 mg for non-response (n:74, 24.7%), suboptimal response (n:159, 53.0%), or durability-driven reasons (n:67, 22.3%). Longitudinal data from the 6 months preceding the switch and post-switch visits at 3 and 6 months were analyzed. The primary outcome was change in best-corrected visual acuity (BCVA, ETDRS letters) from the switch visit to the 3-month post-switch visit. Secondary outcomes included changes in central subfield thickness (CST) and retinal fluid status.
RESULTS: During the pre-switch period, mean BCVA declined by - 1.9 ± 8.2 letters and CST increased. At 3 months after switching, BCVA improved by + 2.0 ± 9.2 letters (95% CI, + 0.8 to + 3.2; p < 0.01), with greater gains in eyes switched for non-response (+ 2.8 ± 12.6 letters). Mean CST decreased by - 45.3 ± 79.8 µm (95% CI, - 55.4 to - 35.2; p < 0.001), with corresponding reductions in retinal fluid. Anatomical improvements were more pronounced in eyes switched for non-response, whereas more modest but consistent changes were observed in suboptimal and durability-driven groups. Visual and anatomical outcomes were maintained at 6 months.
CONCLUSIONS: In previously treated nAMD eyes, switching to aflibercept 8 mg was associated with reversal of pre-switch anatomical worsening, reduction in retinal fluid, and modest visual gains. Greater responses were observed in eyes with inadequate pre-switch disease control, supporting its role as a treatment escalation strategy in clinical practice.