Comparing anti-VEGFs for DME

In a 1-year comparison of intravitreous aflibercept, bevacizumab and ranibizumab therapy for centre-involved diabetic macular oedema (DME), aflibercept was more effective at improving vision among patients who started treatment at lower levels of visual acuity. In patients with milder baseline levels of visual acuity loss, however, there were no differences, on average, between the three medications.

As published in the New England Journal of Medicine, the Diabetic Retinopathy Clinical Research Network randomly assigned 660 adults with DME involving the macular centre to receive 2.0 mg of intravitreous aflibercept (224 participants), 1.25 mg of bevacizumab (218 participants), or 0.3 mg of ranibizumab. The study took place at 89 clinical sites. Following a protocol-specified algorithm, drugs were administered as often as every 4 weeks.

The researchers used a mean visual-acuity letter score for their analysis. Higher scores on a range of 1 to 100 indicate better visual acuity, with a score of 85 indicating approximately 20/20 vision.

From baseline to 1 year, the mean visual-acuity letter score improved by 13.3 among patients who received aflibercept, by 11.2 among patients who received ranibizumab, and by 9.7 among patients who received bevacizumab.

The researchers noted, however, that despite the apparent greater improvement with aflibercept, the driver was eyes with worse visual acuity at baseline, making the difference not clinically meaningful. Among the 51% of participants who had a baseline initial visual-acuity letter score of 78 to 69, the mean improvement was 8.3 with ranibizumab, 8.0 with aflibercept, and 7.5 with bevacizumab.

Among patients who had an initial letter score of less than 69, the mean improvement was 18.9 with aflibercept, 14.2 with ranibizumab, and 11.8 with bevacizumab.

The researchers concluded that “intravitreous aflibercept, bevacizumab, and ranibizumab were effective and relatively safe treatments for DME causing vision impairment,” and that “when initial visual-acuity loss was mild, there was, on average, little difference in visual acuity at 1 year among the three agents. However, at worse levels of initial visual acuity, aflibercept was more effective at improving vision.”

To read the full study, click here.