Polypoidal choroidal vasculopathy (PCV), a disease found more frequently in the Asia-Pacific region than in Caucasian communities, may soon be treated with aflibercept monotherapy, instead of aflibercept plus rescue photodynamic therapy (PDT).
According to two-year results from the PLANET study, conducted to determine the efficacy and safety of aflibercept monotherapy versus aflibercept with rescue PDT, aflibercept monotherapy was found to have led to favorable vision gains and high rates of polyp inactivation.
This means doctors could do away with costly equipment and unnecessary treatments and patients could avoid unwanted side effects linked to PDT, resulting in a simpler – and better – regimen.
“The PLANET study demonstrates that aflibercept monotherapy is non-inferior to treatments using aflibercept plus active rescue PDT,” said Professor Tien Yin Wong, Singapore National Eye Centre, during the Bayer Satellite Symposium at APVRS 2017, titled:
“Eylea: Extending Horizons in the Management of nAMD and PCV.”
Prof. Wong explained that at week 52, patients (in aflibercept monotherapy group) gained more than 10 letters, and this was maintained to week 96; 94% of patients avoided loss of 15 letters or more over 96 weeks. Seventy seven percent (77%) of patients had a dry retina at week 12, with 81% remaining dry by week 96; 80% had inactive polyps at week 52, and this remained at week 96. More than 80% of patients required no rescue PDT treatment over the two-year period.
The treat-and-extend regimen was allowed in the second year of PLANET as an alternative to fixed dosing. Intervals of 10 and 12 weeks were used for 55% and 39% of patients, respectively. Patients with 10- and 12-week intervals had outcomes similar to the overall population, and a reduction of 1-2 injections compared with patients who received fixed dosing.
Indocyanine green angiography (ICGA) is required in order to guide PDT, and it was noted that some clinics do not have PDT and ICGA.
“Aflibercept monotherapy has several advantages over PDT combination therapy,” said Professor Won Ki Lee, from Seoul St. Mary’s Hospital, South Korea. “It avoids potential side effects associated with long-term PDT use, is a simple regimen not requiring access to specialist and provides excellent outcomes in diverse disease subtypes. After positive outcomes with aflibercept monotherapy, questions have been raised concerning the role of PDT combination in the treatment of PCV,” he told the symposium audience.
Professor Masahito Ohji from Shiga University of Medical Science in Japan, presented on data from the ALTAIR treat-and-extend study which adds to the growing body of evidence supporting the use of monotherapy. The Phase IV ALTAIR clinical trial evaluated the efficacy and safety of aflibercept with variable treatment intervals in Japanese patients with nAMD. It was found that the efficacy of aflibercept treat-and-extend regimens remains with either 2- or 4-week adjustments.
PCV is a subtype of exudative age-related macular degeneration (AMD) that can cause permanent vision loss due to hemorrhage, exudation, macular edema, and disciform scar formation. In view of the potential visual loss associated with the natural history, PCV patients should therefore be treated accordingly.
Editor’s Note: A version of this article first appeared at the APVRS 2017 Show Daily Issue 3, the official conference news of APVRS 2017 (Kuala Lumpur, Malaysia) published by PIE Magazine (www.piemagazine.org).
