Early outcomes of switching from bevacizumab to aflibercept-jbvf in exudative macular diseases: a real-world study

To evaluate very early anatomical and functional outcomes following a switch from intravitreal bevacizumab to aflibercept-jbvf in patients with exudative macular diseases. This prospective, single-center, single-arm interventional cohort study included 53 eyes of 41 patients with diabetic macular edema (DME), macular neovascularization (MNV) secondary to neovascular age-related macular degeneration, or retinal vein occlusion (RVO). This heterogeneous cohort comprised biologically distinct disease entities; therefore, diagnosis-specific analyses were considered exploratory. All eyes received three monthly intravitreal bevacizumab injections followed by a single aflibercept-jbvf injection. Primary outcomes were changes in BCVA and CST from the post-bevacizumab preswitch baseline, assessed immediately before aflibercept-jbvf administration, to 4 weeks after the injection. The Wilcoxon signed-rank test was used for paired comparisons, and generalized estimating equation models accounted for within-patient intereye correlation in bilateral cases. Among 53 eyes, 30 (56.6%) had DME, 18 (34.0%) had MNV, and five (9.4%) had RVO. Median CST decreased from 312 μm (IQR, 275–354 μm) at preswitch baseline to 291 μm (IQR, 255–322 μm) at week 4. The mean CST change was − 22.6 ± 68.1 μm (95% CI, − 40.9 to − 4.2; p = 0.001). Median BCVA was 0.699 logMAR at both the post-bevacizumab preswitch baseline (IQR, 0.495–1.000) and week 4 (IQR, 0.398–1.000). The mean BCVA change was − 0.051 ± 0.230 logMAR (95% CI, − 0.114 to + 0.013; p = 0.129). In the GEE analyses, CST reduction remained statistically significant ( p = 0.005), whereas BCVA change was not significant after adjustment for within-patient intereye correlation (β = −0.051; p = 0.065). No serious adverse events were observed. Administration of aflibercept-jbvf following three monthly bevacizumab injections was temporally associated with a statistically significant but modest very early reduction in CST at 4 weeks in this heterogeneous cohort of exudative macular diseases. Because DME, neovascular AMD-related MNV, and RVO represent biologically and clinically distinct disease entities, the pooled findings should be interpreted as descriptive cohort-level estimates within this shared treatment pathway rather than as evidence of a uniform treatment effect across these conditions. A small numerical trend toward BCVA improvement was observed, but the change was not statistically significant in either the unadjusted or GEE-adjusted analysis. Because this was a single-arm study without a comparator group, the observed anatomical change cannot be attributed specifically to aflibercept-jbvf and may partly reflect a delayed or cumulative response to prior bevacizumab, regression to the mean, or natural variability in retinal thickness. Diagnosis-specific findings were exploratory, and the 4-week endpoint does not provide information regarding durability of response or longer-term treatment burden.