Aflibercept administration in neovascular age-related macular degeneration refractory to previous anti-vascular endothelial growth factor drugs

a critical review and new possible approaches to move forward

Stefano Lazzeri, Guido Ripandelli, Maria Sole Sartini, Mariacristina Parravano, Monica Varano, Marco Nardi, Teresa Di Desidero, Paola Orlandi, Guido Bocci

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Purpose: The recent introduction of anti-VEGF drugs has widely changed the prognosis of exudative age-related macular degeneration (AMD), even if a variable percentage of patients showed an insufficient response. Aflibercept is a new anti-VEGF drug approved by FDA for the treatment of exudative AMD with a wider binding capacity than either bevacizumab or ranibizumab. Therefore, the purposes were as follows: (i) to report anatomical and functional outcomes of switching from bevacizumab/ranibizumab to aflibercept previously described in the scientific literature, (ii) to hypothesize the possible pathophysiological mechanisms of the resistance and tachyphylaxis to anti-VEGF drugs, and (iii) to suggest possible clinical actions to increase the chances of success for such difficult cases. Methods: We reviewed the available scientific literature in Medline, Cochrane database, Current Contents, PubMed, and cross-referencing from identified articles, regarding the treatment of exudative AMD patients refractory to bevacizumab and/or ranibizumab and switched to aflibercept monotherapy. We included in this review all the cases in which the diagnosis of refractory or resistant exudative AMD was properly made, and the results of at least one aflibercept injection were described. Findings: We reported the outcomes of 21 papers for a total of 1066 eyes affected by exudative AMD resistant to previous anti-VEGF drug injections and switched to aflibercept. Enrolled reports were divided into two groups: 5 prospective reports and 16 retrospective reports. All the reported papers conclude their analysis, stating that switching from bevacizumab/ranibizumab to aflibercept injections can improve outcomes successfully in refractory neovascular AMD patients. Implications: Analysis of the papers reported in this review demonstrates that switching from bevacizumab/ranibizumab to aflibercept injections can improve outcomes successfully in refractory neovascular AMD patients. The mechanism for these effects is not yet completely understood.

Original languageEnglish
Pages (from-to)397-432
Number of pages36
JournalAngiogenesis
Volume18
Issue number4
DOIs
Publication statusPublished - Oct 1 2015

Fingerprint

Macular Degeneration
Refractory materials
Vascular Endothelial Growth Factor A
Pharmaceutical Preparations
Literature
Injections
Tachyphylaxis
aflibercept
PubMed
Ranibizumab
Bevacizumab
Databases
Therapeutics

Keywords

  • Aflibercept
  • Anti-VEGF drug
  • Intravitreal injections
  • Recurrent exudative AMD
  • Resistant wet AMD

ASJC Scopus subject areas

  • Cancer Research
  • Physiology
  • Clinical Biochemistry

Cite this

Aflibercept administration in neovascular age-related macular degeneration refractory to previous anti-vascular endothelial growth factor drugs : a critical review and new possible approaches to move forward. / Lazzeri, Stefano; Ripandelli, Guido; Sartini, Maria Sole; Parravano, Mariacristina; Varano, Monica; Nardi, Marco; Di Desidero, Teresa; Orlandi, Paola; Bocci, Guido.

In: Angiogenesis, Vol. 18, No. 4, 01.10.2015, p. 397-432.

Research output: Contribution to journalArticle

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AU - Sartini, Maria Sole

AU - Parravano, Mariacristina

AU - Varano, Monica

AU - Nardi, Marco

AU - Di Desidero, Teresa

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