The choice of which anti-vascular endothelial growth factor (VEGF) agent to use on patients with diabetic macular edema (DME) may depend on a variety of variables.
The choice of which anti-vascular endothelial growth factor (VEGF) agent to use on patients with diabetic macular edema (DME) may depend on a variety of variables, including baseline visual acuity (VA), a new meta-analysis has found.1
Pham et al.1 evaluated head-to-head randomized controlled trials (RCTs) comparing aflibercept, bevacizumab, and ranibizumab (or any combination of head-to-head comparisons) in adult patients aged ≥18 years with choroidal neovascular age-related macular degeneration (AMD), DME, macular edema due to retinal vein occlusion, or myopic choroidal neovascularization. The group found three RCTs on DME to include.
“We summarized information regarding treatment regimens (eg, three initial monthly intravitreal injections and as-needed monthly retreatment, treat and extend), as-needed re-treatment criteria and the reconstitution of bevacizumab, and examined the influence of the choice of treatment regimens on the benefits and harms of the anti-VEGF drugs for specific retinal conditions,” the authors wrote.
They excluded any RCT that compared an anti-VEGF agent with other treatments (photodynamic therapy, intravitreal corticosteroids, or grid laser photocoagulation) and limited the study inclusion criteria to only those published in English.
For the patients with DME, the treatment effect estimates were obtained for “all patients” and for subgroups based on baseline best-corrected visual acuity (BCVA).
In general, the group found vision gain was not significantly different in patients with DME treated with bevacizumab compared with ranibizumab.
However, patients with DME treated with aflibercept experienced “significantly higher vision gain at 12 months than patients receiving ranibizumab or bevacizumab,” but the differences were no longer statistically significant at 24 months.1
1. Pham B, Thomas SM, Lillie E, et al. Anti-vascular endothelial growth factor treatment for retinal conditions: a systematic review and meta-analysis. BMJ Open 2019;9(5):e022031.
2. Wells JA, Glassman AR, Ayala AR, et al. Aflibercept, Bevacizumab, or Ranibizumab for Diabetic Macular Edema: Two-Year Results from a Comparative Effectiveness Randomized Clinical Trial. Ophthalmology 2016 123(6):1351-9.
3. Fouda SM, Bahgat AM. Intravitreal aflibercept versus intravitreal ranibizumab for the treatment of diabetic macular edema. Clin Ophthalmol 2017;11:567-71.
4. Ekinci M, Ceylan E, Çakıcı Ö, et al. Treatment of macular edema in diabetic retinopathy: comparison of the efficacy of intravitreal bevacizumab and ranibizumab injections. Expert Review of Ophthalmology 2014;9(2):139-43.