For patients with diabetic macular edema (DME), intravitreal anti-vascular endothelial growth factor (VEGF) agents have become the first-line treatment. There are currently only two VEGF inhibitors approved for use in the United States for the treatment of DME: aflibercept (Eylea, Regeneron) and ranibizumab (Lucentis, Genentech). Bevacizumab (Avastin, Genentech) is often used off-label, and pegaptanib (Macugen, Bausch + Lomb) has declined in use since the introduction of both aflibercept and ranibizumab.
Numerous clinical trials have shown both visual acuity (VA) and anatomic outcomes can be improved with the use of the anti-VEGFs, yet reports of persistent DME remain despite continuous anti-VEGF therapy. Extension studies of RESTORE, RISE and RIDE all show a decline in VA when patients were transitioned to a more flexible treatment after being on a fixed dosing regimen.1, 2
The SWAP-TWO study was a prospective, interventional, single-arm study (Cole Eye Institute) that enrolled 20 eyes of 20 patients between December 2015 and August 2017 to evaluate the effects of switching patients with DME to aflibercept after being previously treated with other anti-VEGF agents;
the study also placed these patients on a fixed dosing regimen. This initial 6-month interim analysis suggests switching agents can substantially improve anatomic outcomes while maintaining vision gains.
1. Boyer DS, Nguyen QD, Brown DM, Basu K, Ehrlich JS: Outcomes with As-Needed Ranibizumab after Initial Monthly Therapy: Long-Term Outcomes of the Phase III RIDE and RISE Trials. Ophthalmology. 2015, 122(12):2504-2513.e2501.
2. Schmidt-Erfurth U, Lang GE, Holz FG, Schlingemann RO, Lanzetta P, Massin P, Gerstner O, Bouazza AS, Shen H, Osborne A et al: Three-year outcomes of individualized ranibizumab treatment in patients with diabetic macular edema: the RESTORE extension study. Ophthalmology. 2014, 121(5):1045-1053.
3. Babiuch AS, Conti TF, Conti FF, Silva FQ, Rachitskaya A, Yuan A, Singh RP: Diabetic macular edema treated with intravitreal aflibercept injection after treatment with other anti-VEGF agents (SWAP-TWO study): 6-month interim analysis. Int J Retina Vitreous. 2019, 5:17.