• Real-World Efficacy of Anti-VEGF Drugs for DME

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD

    Journal Highlights

    Ophthalmology, May 2020

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    Although aflibercept and ranibizumab have shown efficacy in clinical trials of diabetic macular edema (DME), less is known about their benefit in clinical settings. To address this, Bhandari et al. analyzed registry data for patients with DME and found that both drugs were efficacious in treating the condition. Aflibercept produced slightly better anatomic outcomes, as well as greater visual improvement in patients with poorer baseline visual acuity (VA).

    The observational Fight Retinal Blindness! registry was mined for data on patients with DME treated in various countries from Dec. 1, 2013, through June 1, 2018. Treatment choice (aflibercept or ranibizumab) and visit frequency were individualized for each patient by the practitioner. The main outcome was mean change in VA from baseline to month 12.

    The sample included 383 treatment-naive eyes of 291 patients; initial treat­ment was aflibercept in 217 eyes and ranibizumab in 166. At baseline, the ranibizumab group was older (mean difference, +2.7 years), and the afliber­cept group had lower mean VA (mean difference, ‒3.1 letters) and thicker maculae (mean difference, +26 μm); differences were not significant.

    By 12 months, VA gains were similar for the study arms if baseline VA was ≥69 letters (Snellen 20/40 or better): 1.4 for aflibercept and 0.4 for ranibizumab (p = .4). However, more of the patients treated with aflibercept gained ≥10 let­ters. If mean baseline VA was ≤68 letters (20/50), VA gains were 10.6 and 7.6 letters for aflibercept and ranibizumab, respectively (p < .01).

    Reduction in central subfield thick­ness (CST) was greater with aflibercept than ranibizumab, regardless of initial VA: At 20/40, CST reductions were ‒85 and ‒55 μm, respectively (p < .01); at 20/50 vision, reductions were ‒148 and ‒102 μm, respectively (p < .02).

    The median number of injections during the year of treatment was eight for aflibercept and six for ranibizumab (p = .13). Few patients switched treat­ment, and the loss to follow-up was greater in the aflibercept group (21% vs. 9%; p < .01). Most switches were from ranibizumab to aflibercept.

    The authors’ observations are con­sistent with results of pivotal clinical trials and meta-analyses of these drugs. However, in this study, aflibercept led to greater visual gains in patients with poor baseline VA as well as larger CST reductions, which may be ascribed to more advanced disease at presentation, said the authors. They recommend longer-term observational studies of intravitreal therapy for DME.

    The original article can be found here.