Efficacy of switching from existing anti-vascular endothelial growth factor drugs to ranibizumab biosimilar in neovascular age-related macular degeneration

TL;DR

Switching from aflibercept to ranibizumab biosimilar maintains disease control and cytokine balance in neovascular age-related macular degeneration patients.

Contribution

Demonstrates that ranibizumab biosimilar is a viable and cost-effective alternative to aflibercept for long-term treatment of nAMD.

Findings

94.3% of patients maintained disease stability for over one year after switching drugs.

VEGF-A levels increased after switching but remained lower than in control eyes.

PlGF levels remained significantly higher in nAMD eyes compared to controls before and after switching.

Abstract

This study evaluated the clinical outcomes and aqueous humor cytokine levels in eyes with neovascular age-related macular degeneration (nAMD) switched from intravitreal aflibercept to ranibizumab biosimilar (BS).

Prospective observational study.

Thirty-eight eyes of 38 patients with nAMD who received aflibercept under a treat-and-extend (TAE) regimen were prospectively switched to ranibizumab BS. Eight eyes with cataracts undergoing surgery served as controls for aqueous humor cytokine analysis. Best-corrected visual acuity (BCVA) and anatomical outcomes were assessed over one year. The aqueous humor levels of vascular endothelial growth factor (VEGF)-A, angiopoietin-2 (Ang-2), and placental growth factor (PlGF) were measured before and after switching in eyes with nAMD and at surgery in controls.

Disease activity remained controlled in 94.3% of patients with nAMD for over one year. No significant changes were observed in the BCVA (P=0.65) after one year. Ang-2 levels remained unchanged (P=0.66) and were not significantly different between eyes with nAMD and controls both before (P=0.64) and after switching (P=0.30). PlGF levels also remained stable (P=0.12) but were significantly higher in eyes with nAMD than in controls both before (P<0.01) and after switching (P=0.03). VEGF-A levels significantly increased after switching (P<0.01) but remained lower than in the controls both before (P<0.01) and after switching (P=0.02).

Switching from aflibercept to ranibizumab BS effectively maintained disease stability and cytokine balance in eyes with nAMD. These findings support ranibizumab BS as a viable and cost-effective alternative for long-term treatment.

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