Ranibizumab treatment history as predictor of the switch-response to aflibercept: evidence for drug tolerance

Ali Dirani, Irmela Mantel Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland Purpose: To investigate whether tolerance to the anti-VEGF drug, ranibizumab, develops after drug exposure and to determine whether the histo...

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Autores principales:	Dirani A, Mantel I
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	nAMD Ranibizumab Aflibercept Treatment History Switch-Response Drug Tolerance Hypothesis Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/493016c59bc24385b913ef10b49a8f80
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spelling	oai:doaj.org-article:493016c59bc24385b913ef10b49a8f802021-12-02T02:08:25ZRanibizumab treatment history as predictor of the switch-response to aflibercept: evidence for drug tolerance1177-5483https://doaj.org/article/493016c59bc24385b913ef10b49a8f802018-03-01T00:00:00Zhttps://www.dovepress.com/ranibizumab-treatment-history-as-predictor-of-the-switch-response-to-a-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Ali Dirani, Irmela Mantel Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland Purpose: To investigate whether tolerance to the anti-VEGF drug, ranibizumab, develops after drug exposure and to determine whether the history of treatment with ranibizumab prior to refractoriness can predict the post-switching responses to aflibercept. Methods: We retrospectively investigated neovascular age-related macular degeneration patients refractory to ranibizumab (intra- or subretinal fluid despite monthly injections for ≥6 months) who were switched to aflibercept and were followed up for at least 12 months on each of ranibizumab and aflibercept. Baseline characteristics and ranibizumab and aflibercept treatment history (number of injections during the first year and central retinal thickness [CRT]) were analyzed by univariate and multivariate correlation analyses. Results: Ninety-eight eyes (88 patients, 70% females, mean age 77.5 years), including a high proportion of eyes with pigment epithelium detachment (63%), were treated with a mean of 26.2 injections during 36.8 months before switching to aflibercept. The number of ranibizumab injections required in the first year (p=0.0002) and the presence of pigment epithelium detachment (p=0.025) predicted the number of post-switching aflibercept injections required. The post-switching CRT change was predicted by the CRT increase from Month 3 to the switch time point (p<0.0001). Moreover, the CRT change correlated with the visual acuity benefit post-switching (p=0.038 and p=0.004, at 3 and 12 months post-switching, respectively). Conclusion: Ranibizumab treatment history before switching to aflibercept correlates with the post-switching response in terms of the number of drug injections needed and CRT. Thus, drug tolerance does indeed exist and this might help to identify switching candidates. Keywords: nAMD, ranibizumab, aflibercept, treatment history, switch-response, drug tolerance hypothesisDirani AMantel IDove Medical PressarticlenAMDRanibizumabAfliberceptTreatment HistorySwitch-ResponseDrug Tolerance HypothesisOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 12, Pp 593-600 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	nAMD Ranibizumab Aflibercept Treatment History Switch-Response Drug Tolerance Hypothesis Ophthalmology RE1-994
spellingShingle	nAMD Ranibizumab Aflibercept Treatment History Switch-Response Drug Tolerance Hypothesis Ophthalmology RE1-994 Dirani A Mantel I Ranibizumab treatment history as predictor of the switch-response to aflibercept: evidence for drug tolerance
description	Ali Dirani, Irmela Mantel Department of Ophthalmology, University of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland Purpose: To investigate whether tolerance to the anti-VEGF drug, ranibizumab, develops after drug exposure and to determine whether the history of treatment with ranibizumab prior to refractoriness can predict the post-switching responses to aflibercept. Methods: We retrospectively investigated neovascular age-related macular degeneration patients refractory to ranibizumab (intra- or subretinal fluid despite monthly injections for ≥6 months) who were switched to aflibercept and were followed up for at least 12 months on each of ranibizumab and aflibercept. Baseline characteristics and ranibizumab and aflibercept treatment history (number of injections during the first year and central retinal thickness [CRT]) were analyzed by univariate and multivariate correlation analyses. Results: Ninety-eight eyes (88 patients, 70% females, mean age 77.5 years), including a high proportion of eyes with pigment epithelium detachment (63%), were treated with a mean of 26.2 injections during 36.8 months before switching to aflibercept. The number of ranibizumab injections required in the first year (p=0.0002) and the presence of pigment epithelium detachment (p=0.025) predicted the number of post-switching aflibercept injections required. The post-switching CRT change was predicted by the CRT increase from Month 3 to the switch time point (p<0.0001). Moreover, the CRT change correlated with the visual acuity benefit post-switching (p=0.038 and p=0.004, at 3 and 12 months post-switching, respectively). Conclusion: Ranibizumab treatment history before switching to aflibercept correlates with the post-switching response in terms of the number of drug injections needed and CRT. Thus, drug tolerance does indeed exist and this might help to identify switching candidates. Keywords: nAMD, ranibizumab, aflibercept, treatment history, switch-response, drug tolerance hypothesis
format	article
author	Dirani A Mantel I
author_facet	Dirani A Mantel I
author_sort	Dirani A
title	Ranibizumab treatment history as predictor of the switch-response to aflibercept: evidence for drug tolerance
title_short	Ranibizumab treatment history as predictor of the switch-response to aflibercept: evidence for drug tolerance
title_full	Ranibizumab treatment history as predictor of the switch-response to aflibercept: evidence for drug tolerance
title_fullStr	Ranibizumab treatment history as predictor of the switch-response to aflibercept: evidence for drug tolerance
title_full_unstemmed	Ranibizumab treatment history as predictor of the switch-response to aflibercept: evidence for drug tolerance
title_sort	ranibizumab treatment history as predictor of the switch-response to aflibercept: evidence for drug tolerance
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/493016c59bc24385b913ef10b49a8f80
work_keys_str_mv	AT dirania ranibizumabtreatmenthistoryaspredictoroftheswitchresponsetoafliberceptevidencefordrugtolerance AT manteli ranibizumabtreatmenthistoryaspredictoroftheswitchresponsetoafliberceptevidencefordrugtolerance
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Ranibizumab treatment history as predictor of the switch-response to aflibercept: evidence for drug tolerance

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