After concluding the ASSESS prospective trial performed at Cole Eye Institute, researchers were encouraged to learn that switching patients with age-related macular degeneration (AMD) from Avastin (bevacizumab, Genentech) or Lucentis (ranibizumab, Genentech) to a fixed bimonthly intravitreal injection of Eylea (aflibercept, Regeneron) for two years provided statistically significant improvement in central subfoveal thickness and vision compared with baseline. However, the study then followed the 32 participants for another 12 months as they moved back into routine care, and the results were disheartening.

The routine care, mostly consisting of variable treatment regimens, led to a slow decrease in visual gains. At baseline, 22% of participants had visual acuity of 20/200 or worse, which fell to just 5.5% at 24 months of fixed bimonthly treatment. After the next 12 months of follow-up, that percentage jumped back up to 16.7%. 

A variable regimen and the risk of under-treatment undermine the positive study results gained with a fixed, bimonthly AMD treatment schedule, the study authors concluded.

Conti FF, Silva FQ, Srivastava SK, et al. 36-month evaluation of intravitreous aflibercept injection for wet age-related macular degeneration in patients previously treated with ranibizumab or bevacizumab. Ophthalmic Surg Lasers Imaging Retina. 2018;49(3):179-85.