Intravitreal aflibercept for macular edema secondary to central retinal vein occlusion: 18-month results of the phase 3 GALILEO study

Purpose: To evaluate intravitreal aflibercept for treatment of macular edema secondary to central retinal vein occlusion (CRVO).Design: Randomized, double-masked, phase 3 study.Methods: A total of 177 patients with macular edema secondary to CRVO were randomized to receive 2 mg intravitreal aflibercept (n[106) or sham (n[71) every 4 weeks for 20 weeks. From weeks 24 to 48, patients were monitored every 4 weeks; the former group received intravitreal aflibercept as needed (PRN), and the sham group received sham. From weeks 52 to 76, patients were monitored every 8 weeks, and both groups received intravitreal aflibercept PRN. The primary endpoint (proportion of patients who gained ≥15 letters) was at week 24. This study reports exploratory outcomes at week 76.Results: The proportion of patients who gained ≥15 letters in the intravitreal aflibercept and sham groups was 60.2%vs 22.1%at week 24 (patients discontinued before week 24 were considered nonresponders; P < .0001), 60.2% vs 32.4% at week 52 (last observation carried forward, P <.001), and 57.3% vs 29.4% at week 76 (last observation carried forward; P < .001). Mean mm change from baseline central retinal thickness was L448.6 vs L169.3 at week 24 (P < .0001), L423.5 vs L219.3 at week 52 (P < .0001), and L389.4 vs L306.4 at week 76 (P = .1122). Over 76 weeks, the most common ocular serious adverse event in the intravitreal aflibercept group was macular edema (3.8%).Conclusion: The visual and anatomic improvements seen after fixed, monthly dosing at week 24 were largely maintained when treatment intervals were extended. Patients with macular edema following CRVO benefited from early treatment with intravitreal aflibercept.