A clinical research report, published in the journal Ophthalmology, has found that two leading anti-VEGF treatments had shown beneficial outcomes for DME in a study of real word data. The study found that both aflibercept (Eylea) and ranibizumab (Lucentis) were effective for DME over 12 months, identifying that aflibercept had somewhat better anatomic outcomes. In addition, larger visual acuity (VA) gains were observed in eyes on aflibercept treatment when the initial VA was ≤ 68 letters (20/50). In commenting on the research, the authors stated that, “both drugs were beneficial for DME. Aflibercept-treated eyes, which had borderline worse vision and thicker maculae at baseline, had larger reductions in CST after 12 months of treatment. Larger gains in VA (were) observed with aflibercept treatment when the initial VA was less than 20/50.”
The study was part of the “Fight Retinal Blindness! Project”, which was led by clinicians at the University of Sydney, the Royal Free London NHS Foundation Trust, University of Milan, Dijon University Hospital and the University Hospital Zurich, originally established in 2009. The current study included an analysis on treatment-naïve eyes that started DME treatment with either ranibizumab (0.5mg Lucentis, Genentech Inc/Novartis) or aflibercept (2mg Eylea, Bayer) from 1 December 2013 to 1 June 2018 (having at least 12 months of observations after the initial treatment). A total of 383 treatment-naïve eyes (166 ranibizumab and 217 aflibercept) were identified in the study showing that eyes of patients in the aflibercept group had a lower mean VA (mean difference [MD] -3.1 letters) and a thicker maculae (MD +26μm) than those of ranibizumab at baseline, which was not significantly different. The researchers reported that patients on ranibizumab were older (MD +2.7 years) and summarised the results showing that the adjusted mean difference in VA change and central subfield thickness (CST) reduction were +1 letter (1.4 for aflibercept versus 0.4 for ranibizumab, p = 0.4) and -30 microns (-85 versus -55, p<0.01) in eyes with initial VA ≥ 20/40 and +3 letters (10.6 versus 7.6, p<0.01) and -46 microns (-148 versus -102, p<0.02) in those presenting with VA ≤ 20/50. In addition, eyes in the aflibercept group received more injections over 12 months, median of 8, compared to a median of 6 in the ranibizumab group, which this difference was not reported significant (p = 0.13).
In the summary of the study, researchers found that eyes in the aflibercept group had larger vision gains than those in the ranibizumab group at 12 months from the start of treatment, although baseline characteristics were not ideally matched.