Researchers investigating the efficacy of ranibizumab and aflibercept in the treatment of neovascular age-related macular degeneration (nAMD) found the two were comparable in terms of visual acuity (VA) outcomes and treatment frequency at the three-year mark. This was the first study to look at the effects of both beyond two years of therapy.

This retrospective analysis evaluated 965 eyes of 897 patients—469 (499 eyes) treated with ranibizumab and 432 (466 eyes) treated with aflibercept. The team analyzed VA annually in eyes of participants who finished three years of treatment and in all eyes to find the mean change in VA.

They discovered that the mean VA and the type of choroidal neovascular (CNV) lesion at baseline were similar between both groups. After three years of treatment, the mean VA change was similar between both groups: +1.5 letters for ranibizumab and +1.6 for aflibercept. The mean adjusted change in VA was +0.3 vs. +1.0, respectively.

The researchers added that those who completed three years of therapy received a median of 18 injections regardless of the anti-VEGF used, from a median of 21 clinical visits. Even when the CNV was deemed active, the number of clinical visits remained steady between the two agents, the researchers noted. A similar proportion of eyes did not complete three years of treatment in each group, although more eyes switched from ranibizumab to aflibercept than vice versa.

“These data suggest ranibizumab and aflibercept achieve similar visual outcomes for nAMD in routine clinical practice with the same mean number of injections over a three-year time frame,” the study authors concluded in their paper. “Other issues, such as cost, convenience and availability, may be more useful to guide a patient and physician’s choice of drug rather than the relative efficacy of the currently available drugs.” 

Bhandari S, Nguyen V, Arnold J, et al. Treatment outcomes of ranibizumab versus aflibercept for neovascular age-related macular degeneration: data from the Flight Retinal Blindness! Registry. Ophthalmology. October 11, 2019. [Epub ahead of print].