Initial Response of Switching to Aflibercept 8 mg for Neovascular Age-Related Macular Degeneration

Objectives: To assess the initial anatomical and functional outcomes of switching to aflibercept 8 mg in patients with neovascular age-related macular degeneration (nAMD) previously treated with anti-vascular endothelial growth factor (VEGF) therapy. Methods: Patients with nAMD previously treated with anti-VEGF drugs were switched to aflibercept 8 mg. Patients with any exudative changes (subretinal fluid [SRF], intraretinal fluid [IRF], or serous pigment epithelial detachment [sPED]) at the time of the first aflibercept 8 mg injection, and whose dosing interval before and after switching did not differ by more than ±7 days, were included. Best-corrected visual acuity (BCVA), central foveal thickness (CFT), and presence of SRF, IRF, and sPED were evaluated before and after switching to aflibercept 8 mg. Results: A total of 102 eyes from 98 patients were included in the analysis. The drugs used prior to switching were faricimab in five eyes, brolucizumab in six eyes, and aflibercept 2 mg in 91 eyes, with a mean interval of 63.7 ± 20.0 days from the last pre-switch injection and 64.9 ± 20.1 days to the first post-switch visit. The CFT was significantly reduced from 272 ± 85 to 246 ± 79 (p<0.0001). The BCVA remained unchanged at 0.27 ± 0.35. During switching, SRF, IRF, and sPED were observed in 70, 24, and 38 eyes, respectively. At post-switch visit, complete resolution of exudative changes was observed in 44% of eyes with SRF, 55% with IRF, and 29% with sPED. No ocular or systemic adverse effects were observed. Conclusions: As an initial response to switching to aflibercept 8 mg in a real-world setting, SRF and IRF completely resolved in approximately half of the patients, and sPED resolved in about 30% of cases.