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Purpose:

To describe the main reason for aflibercept prescription in the treatment of exudative age-related macular degeneration (AMD) during the initial weeks of availability of this drug in a clinical setting.

Patients and methods:

During the first 16 weeks of availability in France, four experienced practitioners in retinal disease detailed the main reason that led to aflibercept prescription. The charts of these patients were reviewed to collect retrospectively the following data: date of aflibercept injection, age, gender, side, eye naïve of anti-VEGF therapy or previously treated with Ranibizumab, number of injections, and duration of anti-VEGF therapy.

Results:

The study included 313 eyes of 284 patients. Twenty-nine patients (10%) started a bilateral intravitreal aflibercept treatment and 256 patients (90%) had a unilateral treatment during this time.

For the group of eyes formerly treated with ranibizumab, the median number of previous intravitreal anti-VEGF injections was 12 (range 1-55); the median time between the first anti-VEGF injection and the switch to aflibercept was 20 months (range 1-95).

Twenty-five eyes (8,8%) were changed into aflibercept treatment during the loading phase or immediately after the third ranibizumab injection.

For patients eyes previously treated with ranibizumab, the main reason of aflibercept prescription was non responding to ranibizumab (43%).

For patients eyes naïve of anti-VEGF injection, the main reason of aflibercept prescription was ophthalmologist’s will to form his own opinion (39%).

Seven eyes (23%) initially treated with aflibercept, had also the fellow eye treated with aflibercept.

Conclusions:

Exudative AMD is a chronic disease and naïve patients are rare compared to previously treated patients. Unsatisfactory results with ranibizumab were the main reason for switching to aflibercept. Ophthalmologist’s will to form his own opinion was the main reason in naïve patients. These results may serve for comparison in future studies evaluating the trends for treatment in exudative AMD.