Abstract | INTRODUCTION: AZURE was a 76-week, randomized, open-label, parallel-group, phase IIIb noninferiority study comparing the efficacy and safety of intravitreal aflibercept (IVT-AFL) in a treat-and-extend (T&E) regimen with fixed dosing in patients with neovascular age-related macular degeneration (nAMD) previously receiving IVT-AFL for ≥ 1 year. METHODS: Patients were aged ≥ 51 years and had completed ≥ 1 year of IVT-AFL treatment prior to enrollment (IVT-AFL once per month [- 1 or + 2 weeks] for 3 months followed by IVT-AFL every 2 months [6-12 weeks]). Patients were randomly assigned (1:1) to receive IVT-AFL 2 mg in either a T&E (minimum treatment interval of 8 weeks with no upper limit, adjusted according to functional and anatomic outcomes, as assessed by the investigator; n = 168), or a fixed dosing regimen (treatment every 8 weeks [± 3 days]; n = 168). The primary endpoint was best-corrected visual acuity (BCVA) change from baseline to week (W) 52. The key secondary endpoint was the proportion of patients maintaining vision (< 15-letter loss) at W52. RESULTS: The full analysis set comprised 332 patients (T&E: n = 165; fixed dosing: n = 167). Mean BCVA change (baseline to W52) was - 0.3 ± 7.5 vs. - 0.5 ± 8.4 letters (T&E vs. fixed dosing; least-squares mean difference [95% CI]: 0.22 [- 1.51 to 1.96] letters; P < 0.0001 for noninferiority test [5-letter margin]). From baseline to W52, 95.2% (T&E) and 94.0% (fixed dosing) of patients maintained vision. Mean central subfield thickness change from baseline to W52 was - 24 ± 55 (T&E) and - 33 ± 47 (fixed dosing) µm. Last treatment interval to W76 was ≥ 12 weeks for 37.0% of T&E patients. No new safety signals were identified. CONCLUSION: IVT-AFL T&E can achieve similar functional and anatomic outcomes to fixed dosing every 8 weeks over 52 weeks in patients with nAMD who have completed ≥ 1 year of treatment, while reducing treatment burden. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02540954.
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Authors | Laurent Kodjikian, Lluís Arias Barquet, András Papp, Peter J Kertes, Edoardo Midena, Jan Ernest, Rufino Silva, Thomas Schmelter, Tobias Niesen, Sergio Leal |
Journal | Advances in therapy
(Adv Ther)
Vol. 41
Issue 3
Pg. 1010-1024
(Mar 2024)
ISSN: 1865-8652 [Electronic] United States |
PMID | 38183525
(Publication Type: Clinical Trial, Phase III, Equivalence Trial, Journal Article, Randomized Controlled Trial)
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Copyright | © 2024. The Author(s). |
Chemical References |
- aflibercept
- Receptors, Vascular Endothelial Growth Factor
- Recombinant Fusion Proteins
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Topics |
- Humans
- Middle Aged
- Intravitreal Injections
- Macular Degeneration
(drug therapy)
- Receptors, Vascular Endothelial Growth Factor
(therapeutic use)
- Recombinant Fusion Proteins
(therapeutic use)
- Treatment Outcome
- Visual Acuity
- Aged
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