Results from the first, large, randomised trial comparing three anti-VEFG agents for the management of diabetic macular edema (DME) have been published in Ophthalmology.
The study showed that while all three agents are effective in treating DME, they are not the same. This is especially the case when treating patients with vision <6/15, where aflibercept provided the best visual acuity and central retinal thickness outcomes, followed by ranibizumab then bevacizumab. The mean VA difference between aflibercept and bevacizumab was almost a line, which can be the difference between driving or not. The study also showed that in the second year of treatment most patients can be effectively managed on approximately half the number of injections used in the first year. Julie Heraghty, Chief Executive Officer of Macular Disease Foundation Australia, said the research was welcomed. “Doctors are guided by evidence based research in their treatment of patients. “The findings are very important for outcomes for patients, their family and carers,” she said.
The trial included 660 patients who were randomised to receive intravitreal injections of 2 mg of Eylea (aflibercept), 1.25 mg of compounded Avastin (bevacizumab) or 0.3 mg of Lucentis (ranibizumab). At the two year follow-up, mean visual acuity improved by 12.8 letters in the aflibercept group, 10 letters in the bevacizumab group and 12.3 letters in the ranibizumab group.
Mean visual acuity improved by 18.3 letters in the aflibercept group, 13.3 letters in the bevacizumab group and 16.1 letters in the ranibizumab group of patients with baseline visual acuity of 20/50 or worse.
Among those with 20/32 to 20/40, mean visual acuity improved by 7.8 letters in the aflibercept group, 6.8 letters in the bevacizumab group and 8.6 letters in the ranibizumab group.