A recent clinical trial studied the difference in the risk of developing new macular atrophy between ranibizumab and aflibercept anti-VEGF therapy when using a treat-and-extend injection regimen. Although the study will continue through 24 months of follow up, the 12-month interim analysis of the mean number of injections and the mean change in best-corrected visual acuity (BCVA) has shown no substantial difference between the two agents.

Of the 278 participants with neovascular age-related macular degeneration (AMD), 127 were randomly assigned to ranibizumab and 121 received aflibercept. Participants received three monthly doses (baseline, week four, week eight) followed by a treat-and-extend regimen, where the injection interval was dependent on any signs of disease activity. The study found that the mean BCVA letter score change from baseline to month 12 was 7.2 and 4.9 for ranibizumab and aflibercept, respectively, but the respective BCVA letter scores of 72.9 and 70.5 were not significantly different. The mean number of injections for the first 12 months was 9.7 in both groups.

The researchers believe that their findings suggest that neither ranibizumab nor aflibercept is superior to the other regarding their efficacy and duration when used in a treat-and-extend regimen for AMD. The data they collect after the full two-year period may identify any advantages one may have over the other. 

Gillies MC, Hunyor AP, Arnold JJ, et al. Effect of ranibizumab and aflibercept on best-corrected visual acuity in treat-and-extend for neovascular age-related macular degeneration: a randomized clinical trial. JAMA Ophthalmol.  January 24, 2019. [Epub ahead of print].