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Intravitreal aflibercept injection for macular edema due to central retinal vein occlusion: two-year results from the COPERNICUS study.

AbstractPURPOSE:
To evaluate the efficacy and safety of intravitreal aflibercept injection (IAI) for the treatment of macular edema secondary to central retinal vein occlusion (CRVO).
DESIGN:
Randomized, double-masked, phase 3 trial.
PARTICIPANTS:
A total of 188 patients with macular edema secondary to CRVO.
METHODS:
Patients received IAI 2 mg (IAI 2Q4) (n = 114) or sham injections (n = 74) every 4 weeks up to week 24. During weeks 24 to 52, patients from both arms were evaluated monthly and received IAI as needed, or pro re nata (PRN) (IAI 2Q4 + PRN and sham + IAI PRN). During weeks 52 to 100, patients were evaluated at least quarterly and received IAI PRN.
MAIN OUTCOME MEASURES:
The primary efficacy end point was the proportion of patients who gained ≥ 15 letters in best-corrected visual acuity (BCVA) from baseline to week 24. This study reports week 100 results.
RESULTS:
The proportion of patients gaining ≥ 15 letters was 56.1% versus 12.3% (P<0.001) at week 24, 55.3% versus 30.1% (P<0.001) at week 52, and 49.1% versus 23.3% (P<0.001) at week 100 in the IAI 2Q4 + PRN and sham + IAI PRN groups, respectively. The mean change from baseline BCVA was also significantly higher in the IAI 2Q4 + PRN group compared with the sham + IAI PRN group at week 24 (+17.3 vs. -4.0 letters; P<0.001), week 52 (+16.2 vs. +3.8 letters; P<0.001), and week 100 (+13.0 vs. +1.5 letters; P<0.0001). The mean reduction from baseline in central retinal thickness was 457.2 versus 144.8 μm (P<0.001) at week 24, 413.0 versus 381.8 μm at week 52 (P = 0.546), and 390.0 versus 343.3 μm at week 100 (P = 0.366) in the IAI 2Q4 + PRN and sham + IAI PRN groups, respectively. The mean number (standard deviation) of PRN injections in the IAI 2Q4 + PRN and sham + IAI PRN groups was 2.7 ± 1.7 versus 3.9 ± 2.0 during weeks 24 to 52 and 3.3 ± 2.1 versus 2.9 ± 2.0 during weeks 52 to 100, respectively. The most frequent ocular serious adverse event from baseline to week 100 was vitreous hemorrhage (0.9% vs. 6.8% in the IAI 2Q4 + PRN and sham + IAI PRN groups, respectively).
CONCLUSIONS:
The visual and anatomic improvements after fixed dosing through week 24 and PRN dosing with monthly monitoring from weeks 24 to 52 were diminished after continued PRN dosing, with a reduced monitoring frequency from weeks 52 to 100.
AuthorsJeffrey S Heier, W Lloyd Clark, David S Boyer, David M Brown, Robert Vitti, Alyson J Berliner, Husain Kazmi, Yu Ma, Brigitte Stemper, Oliver Zeitz, Rupert Sandbrink, Julia A Haller
JournalOphthalmology (Ophthalmology) Vol. 121 Issue 7 Pg. 1414-1420.e1 (Jul 2014) ISSN: 1549-4713 [Electronic] United States
PMID24679444 (Publication Type: Clinical Trial, Phase III, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
CopyrightCopyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Chemical References
  • Recombinant Fusion Proteins
  • aflibercept
  • Receptors, Vascular Endothelial Growth Factor
Topics
  • Adult
  • Aged
  • Double-Blind Method
  • Female
  • Fluorescein Angiography
  • Humans
  • Intravitreal Injections
  • Macular Edema (drug therapy, etiology, physiopathology)
  • Male
  • Middle Aged
  • Receptors, Vascular Endothelial Growth Factor (administration & dosage, adverse effects, therapeutic use)
  • Recombinant Fusion Proteins (administration & dosage, adverse effects, therapeutic use)
  • Retina (pathology)
  • Retinal Vein Occlusion (complications, drug therapy, physiopathology)
  • Surveys and Questionnaires
  • Treatment Outcome
  • Visual Acuity (physiology)

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