For Some, Switching ANTI-VEGF Treatments Midstream Could Be Harmful

Switching from Lucentis to Eylea could result in worsening of the retinal condition of some people with wet (exudative) AMD.
Since the advent of anti-VEGF drug treatments for wet AMD, research has verified that blood vessel growth and leakage (neovascularization) usually diminishes in patients who are switched from either Lucentis or Avastin to Eylea. A small study, however, suggests that some patients may have a negative response to switching from Lucentis to Eylea. The reason is unknown, but the study team thinks it is possible that genetic variants in VEGF-A, which Lucentis specifically targets, might be the cause. Fortunately, the worsening was found to be reversible after returning to Lucentis, with no significant loss of visual acuity.
Researchers looked at 17 eyes of patients whose doctors had switched them from Lucentis to Eylea in an effort to improve their treatment. This is usually an effective choice with no negative consequences, but these particular eyes developed increased subretinal fluid after the switch. The number of patients is very small in comparison with the much greater number who benefit from such a protocol, but doctors now need to be aware that a few patients may actually worsen, at which time corrective action can, and should, be taken before vision loss occurs.
Source: Worsening anatomic outcomes following aflibercept for neovascular age-related macular degeneration in eyes previously well controlled with ranibizumab. Eric Nudleman, Jeremy D Wolfe, Maria A Woodward, Yoshihiro Yonekawa, George A Williams, Tarek S Hassan (Dove Medical Press, 8 June 2016 Volume 2016:10, Pages 1053—1057. DOI