Intravitreal Ranibizumab or Aflibercept After Bevacizumab in Diabetic Macular Edema: Exploratory Retrospective Analysis

Abstract

Aim: To evaluate the efficacy of switching from bevacizumab to ranibizumab or aflibercept in eyes with diabetic macular edema (DME) unresponsive to bevacizumab. Methods: Single-center retrospective comparative study of patients with DME unresponsive to intravitreal bevacizumab that was switched to ranibizumab or aflibercept. Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were analysed prior to and 4 months after the switch. Ocular coherence tomography (OCT) biomarkers were also analysed. Results: Fifty-six eyes from 40 patients were included in the study, 33 eyes switched to ranibizumab and 23 to aflibercept. A significant median CFT decrease was observed in both groups (p<0.001), with no between-group differences. BCVA gain was only significant in the ranibizumab group (p<0.001). None of the pre-baseline or baseline parameters were associated with the response to ranibizumab or aflibercept. Conclusion:In persistent DME unresponsive to bevacizumab, both anatomical and functional improvements were observed with ranibizumab whereas aflibercept only showed an anatomical improvement. Clinicaltrials.gov NCT04018833.

Retrospective analysis of the efficacy of early switching from bevacizumab to aflibercept or ranibizumab in diabetic macular edema

“…5 However, numerous clinical studies are reporting significant anatomical and functional improvement after switching from bevacizumab to aflibercept or ranibizumab due to their higher VEGF binding capacities and longer half-lives. 8,9,11,14–17 Consistent with the literature, in our study, significant improvements were found in CMT and BCVA compared to baseline at 1, 3, 6, and 12 months after switching in both aflibercept and ranibizumab treatment arms. The RISE/RIDE studies compared patients with >10% reduction in CRT at 3 months (immediate responders) with patients with <10% reductions in CRT (delayed responders).…”

“…There are studies in the literature comparing 3 or 6 bevacizumab injections followed by a three-monthly post-switch injection of aflibercept or ranibizumab. 9,15 Pessoa et al reported that 3 injections of aflibercept or ranibizumab provided significant anatomical improvement in DME refractory to bevacizumab injections, but they could not achieve significant functional gain with aflibercept. 9 Alsaedi et al reported that 3 aflibercept or ranibizumab injections had similar anatomical and functional results in DME refractory to bevacizumab injections, and they obtained more dry macula with aflibercept.…”

“…9,15 Pessoa et al reported that 3 injections of aflibercept or ranibizumab provided significant anatomical improvement in DME refractory to bevacizumab injections, but they could not achieve significant functional gain with aflibercept. 9 Alsaedi et al reported that 3 aflibercept or ranibizumab injections had similar anatomical and functional results in DME refractory to bevacizumab injections, and they obtained more dry macula with aflibercept. 15 Our study resulted in harmony with Alsaedi et al, in which they shared their 3-month results, and the presence of 12-month follow-up data is the strength of our study.…”

“…In some of these studies, anatomical and functional gains were reported after switching to aflibercept, 8 while in others, the functional gain was reported to be more significant in eyes that were switched to ranibizumab. 9 The response at 3 months after the switch was evaluated, however, the effects of ranibizumab and aflibercept on DME in the long term were not compared. This study aimed to compare the anatomical and functional gains 12 months after switching to ranibizumab or aflibercept in eyes with treatment-naive DME who did not have the expected response to three bevacizumab injections.…”

DNA methyltransferase expression (DNMT1, DNMT3a and DNMT3b) as a potential biomarker for anti-VEGF diabetic macular edema response

“…Based on Diabetic Retinopathy Clinical Research network (DRCR.net) Protocol I study and others groups only patients with at least three monthly treatments with anti-VEGF with at least 6 months of follow-up were considered. 5,12,19,20 (i) rDME Group: Participants with DME (baseline central subfield thickness ≥305 μm in women and ≥320 μm in men), with a reduction in thickness >10% CRT on SD-OCT 12…”