Four loading doses of aflibercept injections significantly improve macular fluid resolution in AMD patients: Study

A recent study investigated the effectiveness of four loading doses of aflibercept against three on macular fluid resolution and visual acuity (VA) in patients with exudative neovascular age-related macular degeneration (nAMD). The key findings of this study were published in the Eye journal.

This multicenter, retrospective cohort study included treatment-naive nAMD eyes which received either three or four loading doses of aflibercept. This research extensively measured the changes in VA and fluid resolution on optical coherence tomography (OCT) by 8 weeks post-loading. The primary outcome focused on the proportion of patients with no intraretinal (IRF) and/or subretinal fluid (SRF) in the central 1 mm and the entire macula. The continuous variables were summarized using mean ± SD and the categorical variables were presented as n (%).

Out of the 995 patients analyzed, 355 eyes received four loading doses, while 640 eyes received three loading doses. The results expressed a clear advantage for the group which received four injections. By eight weeks post-loading, the proportion of eyes with neither IRF nor SRF at the fovea was 62.8% for the eyes that received four doses when compared to 56.1% for the three-dose group. The absence of IRF was 88.7% when compared to 87.9%, and SRF was absence at the fovea in 79.2% against 69.9% for the four and three-dose groups, respectively. When considering the entire macula, fluid resolution was also higher in the four-dose group. These differences were statistically significant (p = 0.0001) that indicated four loading doses of aflibercept are more effective in resolving macular fluid both at the fovea and across the whole macula.

Increase in visual acuity did not show a statistically significant difference between the two groups amidst the improved fluid resolution with four loading doses. The mean change in VA was +4.0 (±11.3) letters for the three-dose group and +5.4 (±13.3) letters for the four-dose group (p = 0.09). This suggests that while four doses may lead to enhanced fluid resolution this does not completely translate into significantly better short-term VA outcomes. Overall, the outcomes of this study suggest that four loading doses of aflibercept result in a increased proportion of eyes with total fluid resolution in both the central subfield and the total macular scan when compared to three loading doses at 8 weeks following the loading.

Source:

Chandra, S., Raimondi, R., Lim, A., Mohan, A., Melmane, S., Menon, G., Chandran, M., Sivaprasad, S., Burton, B. J. L., & Kotagiri, A. (2024). The effect of four loading intravitreal aflibercept injections on macular fluid in treatment-naïve neovascular age-related macular degeneration. In Eye. Springer Science and Business Media LLC. https://doi.org/10.1038/s41433-024-03214-x