Switching treatments for wet AMD poses numerous complexities

Take-home message: Studies that focus on switching treatments for exudative age-related macular degeneration may represent more real-life scenarios. However, future prospective studies with predetermined switching criteria and follow-up are needed.

 

By Vanessa Caceres; Reviewed by Rishi Singh, MD

Cleveland-Switching treatment is not uncommon in medicine. In fact, a number of studies with patients who have rheumatoid arthritis or multiple sclerosis have found benefits from switching.

Further reading: Patient criteria vital to VMA success

Yet, just how effective is switching medications for patients with exudative age-related macular degeneration (AMD)?

Why make the change?

Common reasons for switching treatments may involve insufficient initial response, reduced response over time (also called tachyphylaxis), clinical trial data that lack real-life application, and the availability of newer agents may offer more benefit.

How insufficient response is defined is “debatable,” said Rishi Singh, MD, staff physician, Cole Eye Institute, Cleveland Clinic, and assistant professor of ophthalmology, Case Western Reserve University, Cleveland.

Insufficient response could be defined by persistence of fluid on optical coherence tomography (OCT), lack of flattening of the pigment epithelial detachment, and the requirement of continued re-treatment.

However, a number of OCT results from randomized, controlled trials show persistent fluid in patients, even after 1 year of treatment, Dr. Singh said.

“It approaches 50% or greater in a number of studies,” he said. “Using this as a definition may not be the best entry point.”

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