Intravitreal Aflibercept for Retinal Angiomatous Proliferation: Results of a prospective case series at 96 weeks

Introduction: Retinal angiomatous proliferation (RAP) is a subtype of neovascular age-related macular degeneration (nAMD). Untreated, the lesions are thought to be aggressive and lead to a poor visual outcome. Despite some limitations, studies reporting the treatment of RAP lesions with the intravitreal anti-VEGF drugs ranibizumab and bevacizumab have demonstrated variable but generally favourable responses. More recently, aflibercept has been licenced for the treatment of nAMD and may offer some advantages over other agents. We present the 96 week visual and anatomical outcomes of patients with RAP lesions treated with intravitreal Aflibercept, using the pivotal VIEW study nAMD treatment protocol. Methods: This is a prospective study of treatment naïve patients with reading centre graded RAP lesions. The patients received aflibercept every 8 weeks after 3 initial monthly injections up to and including week 48. From weeks 52 to 96 patients received injections at least every 12 weeks with monthly evaluations for interim injections if they fulfilled the retreatment criteria. At each visit, best corrected visual acuity (BCVA) and optical coherence tomography (OCT) central macular thickness (CMT) was measured. Results: Forty six patients reached study completion at week 96. Mean BCVA improved by 6.0 (SD=7.9) and 4.8 (SD=7.4) ETDRS letters at 52 (p=0.003) and 96 (p=0.02) weeks respectively, from a baseline of 57.3 (SD=12.0) letters. At the 52 and 96 week time points, 45/46 (98%) and 41/46 (89%) of patients respectively, had maintained their vision (less than 15 letters of BCVA lost). At the 96 week time point, 13/46 (28%) of patients had gained 15 letters or more and also demonstrated a mean reduction in CMT of 162 microns (SD=106) (p=<0.0001), with 72 % of maculae being fluid free. Using univariate analysis, we found no significant difference between any of the visual outcomes measures of the current study and the pivotal View study. The mean number of injections required and the mean change in CMT in each study was also similar. Conclusions: In this study, we present the 96 week results of the largest series to date of patients treated prospectively with aflibercept for RAP using the VIEW protocol and show that they benefit from treatment to a similar degree to those with type 1 and 2 nAMD.