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Purpose <p>Dutch guidelines recommend bevacizumab as first-line treatment for neovascular age-related macular degeneration (nAMD) due to its lower cost and comparable outcomes to other anti-VEGF agents. However, Dutch clinics report higher injection frequencies than international counterparts, raising concerns about treatment burden. This pilot study compares 24-month real-world outcomes of initiating aflibercept versus bevacizumab in Dutch community ophthalmology clinics.</p> Methods <p>We conducted an observational study using prospective data from three Dutch FRB registry clinics. Two clinics used bevacizumab with two-weekly T&amp;E interval adjustments. A third clinic initiated aflibercept with a four-week initial extension, followed by two-weekly adjustments. Primary outcomes were total injections and injections to CNV inactivity. Secondary outcomes included time to CNV inactivity, VA change, and final injection interval.</p> Results <p>We included 43 eyes (38 patients) in the aflibercept group and 129 eyes (119 patients) in the bevacizumab group, matched 1:3 on age and baseline VA. At 24 months, mean VA was 65.6 (aflibercept) vs. 68.8 (bevacizumab) letters (<i>p</i> = 0.182), and mean letter gains were + 0.8 vs. + 4.2 (<i>p</i> = 0.113). Aflibercept-treated eyes received 5.5 fewer injections (<i>p</i> &lt; 0.001), required 5.6 fewer injections to achieve CNV inactivity (<i>p</i> &lt; 0.001), and reached inactivity 20.6 weeks earlier (<i>p</i> = 0.001). Final injection intervals were 3.3 weeks longer with aflibercept (<i>p</i> &lt; 0.001); 41.9% reached intervals ≥ 12 weeks compared to 14.7% in the bevacizumab group (<i>p</i> &lt; 0.001).</p> Conclusion <p>Aflibercept under a modified T&amp;E regimen resulted in fewer injections, faster disease control and longer treatment intervals, while VA was not significantly different.</p> Key messages <Emphasis Type="BoldItalic">What is known</Emphasis> <p><UnorderedList Mark="Bullet"> <ItemContent> <p>Aflibercept and bevacizumab are both widely used anti-VEGF injections for age-related macular degeneration with similar visual outcomes.</p> </ItemContent> <ItemContent> <p>Real-world studies in the Netherlands report a high injection burden with bevacizumab, but direct comparisons between agents in routine care are limited.</p> </ItemContent> </UnorderedList></p> <Emphasis Type="BoldItalic">What is new</Emphasis> <p><UnorderedList Mark="Bullet"> <ItemContent> <p>Aflibercept, initiated with a modified treat-and-extend regimen, achieved visual outcomes comparable to bevacizumab while requiring fewer injections.</p> </ItemContent> <ItemContent> <p>These findings highlight aflibercept’s potential to reduce treatment burden and optimize healthcare resources, warranting confirmation in larger, long-term real-world studies, as well as cost-effectiveness studies.</p> </ItemContent> </UnorderedList></p>

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Real-world treatment outcomes of aflibercept versus bevacizumab for neovascular age-related macular degeneration

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月10日

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  • Haras Mhmud,
  • Jeroen P. Vermeulen,
  • Beritan Adanc,
  • Jeroen B.J. Klevering,
  • Carolien Groenink-Lindenhovius,
  • Odette A.M. Tigchelaar,
  • Theodorus L. Ponsioen,
  • Caroline C.W. Klaver,
  • Antonella N. Witmer

摘要

Purpose

Dutch guidelines recommend bevacizumab as first-line treatment for neovascular age-related macular degeneration (nAMD) due to its lower cost and comparable outcomes to other anti-VEGF agents. However, Dutch clinics report higher injection frequencies than international counterparts, raising concerns about treatment burden. This pilot study compares 24-month real-world outcomes of initiating aflibercept versus bevacizumab in Dutch community ophthalmology clinics.

Methods

We conducted an observational study using prospective data from three Dutch FRB registry clinics. Two clinics used bevacizumab with two-weekly T&E interval adjustments. A third clinic initiated aflibercept with a four-week initial extension, followed by two-weekly adjustments. Primary outcomes were total injections and injections to CNV inactivity. Secondary outcomes included time to CNV inactivity, VA change, and final injection interval.

Results

We included 43 eyes (38 patients) in the aflibercept group and 129 eyes (119 patients) in the bevacizumab group, matched 1:3 on age and baseline VA. At 24 months, mean VA was 65.6 (aflibercept) vs. 68.8 (bevacizumab) letters (p = 0.182), and mean letter gains were + 0.8 vs. + 4.2 (p = 0.113). Aflibercept-treated eyes received 5.5 fewer injections (p < 0.001), required 5.6 fewer injections to achieve CNV inactivity (p < 0.001), and reached inactivity 20.6 weeks earlier (p = 0.001). Final injection intervals were 3.3 weeks longer with aflibercept (p < 0.001); 41.9% reached intervals ≥ 12 weeks compared to 14.7% in the bevacizumab group (p < 0.001).

Conclusion

Aflibercept under a modified T&E regimen resulted in fewer injections, faster disease control and longer treatment intervals, while VA was not significantly different.

Key messages What is known

Aflibercept and bevacizumab are both widely used anti-VEGF injections for age-related macular degeneration with similar visual outcomes.

Real-world studies in the Netherlands report a high injection burden with bevacizumab, but direct comparisons between agents in routine care are limited.

What is new

Aflibercept, initiated with a modified treat-and-extend regimen, achieved visual outcomes comparable to bevacizumab while requiring fewer injections.

These findings highlight aflibercept’s potential to reduce treatment burden and optimize healthcare resources, warranting confirmation in larger, long-term real-world studies, as well as cost-effectiveness studies.