Pravin U. Dugel, MD: Clinical Effectiveness of Switching Between Ranibizumab and Aflibercept in Treatment of Neovascular AMD: US Real-World Outcomes


The purpose of this article is to examine visual acuity (VA) outcomes and treatment patterns in neovascular age-related macular degeneration (nAMD) eyes switching between ranibizumab and aflibercept in routine clinical practice.


Electronic medical records were used to identify nAMD eyes receiving ranibizumab or aflibercept with 12 months’ follow-up since switching antivascular endothelial growth factor (anti-VEGF) therapy. The primary outcome compared mean change in VA between switch and Month 12 to test the noninferiority of switching from ranibizumab to aflibercept vs aflibercept to ranibizumab. Comparing the number of injection/non-injection visits was the key secondary objective.


A total of 269 eyes switching from ranibizumab to aflibercept and 83 switchings from aflibercept to ranibizumab were included. The mean change in VA (letters) after 12 months in eyes switched from ranibizumab to aflibercept, and from aflibercept to ranibizumab, was –1.56 and 0.21, respectively (P = .65). The adjusted difference (95% confidence interval) of mean change at Month 12 was 1.29 (–2.97 to 5.55; P = .55), confirming the noninferiority of ranibizumab. The mean (±SD) number of injections during follow-up was 8.67 (±2.63) for eyes switching from aflibercept to ranibizumab and 7.79 (±2.77) for ranibizumab to aflibercept (P = .01).


Switching between anti-VEGFs is not associated with clinically relevant differences in VA at 12 months in routine clinical practice.