Long-term Safety and Visual Outcome of Intravitreal Aflibercept in Neovascular Age-Related Macular Degeneration: VIEW 1 Extension Study

Peter K Kaiser; Michael Singer; Michael Tolentino; Robert Vitti; Kristine Erickson; Namrata Saroj; Alyson J Berliner; Karen W Chu; Xiaoping Zhu; Zinaria Williams Liu; W Lloyd Clark

doi:10.1016/j.oret.2017.01.004

Long-term Safety and Visual Outcome of Intravitreal Aflibercept in Neovascular Age-Related Macular Degeneration: VIEW 1 Extension Study

Ophthalmol Retina. 2017 Jul-Aug;1(4):304-313. doi: 10.1016/j.oret.2017.01.004. Epub 2017 Mar 18.

Authors

Affiliations

¹ Cole Eye Institute, Cleveland, Ohio.
² Medical Center Ophthalmology Associates, San Antonio, Texas.
³ Center for Retina and Macular Disease, Winter Haven, Florida.
⁴ Regeneron Pharmaceuticals, Inc, Tarrytown, New York.
⁵ Palmetto Retina Center, West Columbia, South Carolina. Electronic address: LClark@palmettoretina.com.

PMID: 31047516
DOI: 10.1016/j.oret.2017.01.004

Abstract

Purpose: To assess the long-term safety and vision change in patients who received intravitreal aflibercept injection (IAI) for neovascular age-related macular degeneration in an extension study after completing VIEW 1 trial.

Design: Prospective, open-label, multicenter, extension study.

Participants: Three hundred twenty-three patients.

Methods: In VIEW 1, 1217 patients were randomized to receive fixed dosing of 0.5 mg IAI every 4 weeks (0.5q4), 2 mg IAI every 4 weeks (2q4), 2 mg IAI every 8 weeks after 3 initial monthly dosing (2q8), or 0.5 mg ranibizumab every 4 weeks (Rq4) from baseline through week 52, followed by modified quarterly injections of the same dose of anti-vascular endothelial growth factor agent from weeks 52 to 96. After completing VIEW 1 at week 96, patients (n = 323) enrolled in an extension study and received 2 mg IAI on a modified quarterly injection schedule followed by at least an every 8-week dosing through week 212.

Main outcome measures: Long-term safety and vision change in patients followed for a median duration of 116 weeks in the extension study (total follow-up time of 212 weeks from the VIEW 1 baseline).

Results: Patients enrolled in the extension study gained a mean of 10.2 letters from the VIEW 1 baseline at week 96. These patients largely maintained vision over the extension study with a mean gain of 7.1 letters from the VIEW 1 baseline to week 212. The proportion of patients who lost ≥15 letters from the VIEW 1 extension baseline was 8.2% at week 212. Mean number of injections was 12.9 (range, 1-41) in the extension study. The most common serious ocular adverse event was endophthalmitis (0.9%). The overall incidence of Antiplatelet Trialists' Collaboration-defined arterial thromboembolic events was 6.2%.

Conclusions: Vision gains achieved with anti-vascular endothelial growth factor therapy in VIEW 1 were largely maintained by continued treatment with IAI 2 mg in the extension study. Anti-vascular endothelial growth factor injections (including 4 years of IAI 2 mg) were well-tolerated with no new safety signals compared with the known profile of IAI.