Twelve months outcomes of ranibizumab vs. aflibercept for neovascular age-related macular degeneration: observational study data

Purpose : To compare the 12-month outcomes of ranibizumab vs. aflibercept therapy for treatment-naïve eyes with neovascular age-related macular degeneration (nAMD) in routine clinical practice. Methods : Eyes commencing treatment over a 10 month recruitment period (01-Dec-2013 to 30-Sep-2014) formed the study population. The primary study outcome was mean change in visual acuity (VA) over 12 months. Secondary outcomes included the proportion of eyes in which the lesion became inactive and the number of injections to first recorded grading as inactive. Results : The study population consisted of 261 eyes of 252 patients treated at 26 practices. Accrual rates over the 10 month recruitment period were similar resulting in similar sized groups (n=131 ranibizumab and n=130 aflibercept). Demographics and clinical characteristics were similar for both groups with mean index VA of 64.2 (ranibizumab) and 62.4 (aflibercept) LogMAR letters. The only significant difference was that the ranibizumab group mean age was 3.8 years older. Group mean 12 month VA outcomes for eyes which completed the study period were similar. The treatment-by-time interaction from the longitudinal model provided no evidence for a difference between the two groups (P=0.456). Group mean VA at 12 months were similar: 70.1 (ranibizumab) vs 68.5 (aflibercept) letters (P=0.604; t-test). Eyes which completed the study period had an average of 8.6 (ranibizumab) and 8.1 (aflibercept) injections (P=0.860, Conway-Maxwell Poisson) and an average of 10.0 (ranibizumab) and 10.1 (aflibercept) visits. Conclusions : We found no difference in the efficacy of ranibizumab vs aflibercept for nAMD in this observational study. Further studies are warranted to determine, for example by genetic testing, whether either agent is superior for individual eyes.