Clinical Effectiveness of Intravitreal Therapy With Ranibizumab vs Aflibercept vs Bevacizumab for Macular Edema Secondary to Central Retinal Vein Occlusion

Abstract

This randomized clinical trial compares the clinical effectiveness of intravitreal therapy with ranibizumab vs aflibercept vs bevacizumab for the management of macular edema secondary to central retinal vein occlusion.

The impact of LEAVO study in Greece

“…Real-life studies for the treatment of macular edema due to CRVO in Greece have shown that intravitreal 0.5 mg ranibizumab and 2.0 mg aflibercept demonstrated similar anatomical and functional outcomes over an 18-month follow-up, using a loading phase of three intravitreal injections and pro re nata regimen thereafter [4]. These findings are in accordance with those of the LEAVO study regarding the two licensed anti-VEGF agents, although the treatment regimens are different [3].…”

“…LEAVO study has shown that bevacizumab was not non-inferior compared with ranibizumab, but aflibercept was non-inferior to ranibizumab at the 100-week follow-up. It is worthy to mention that all three anti-VEGF agents markedly improved and maintained visual acuity, while fewer injections were needed in patients treated with aflibercept [3].…”

Impact of the LEAVO Study in Asia

“…Clinicians might therefore try to reduce the number of initial loading injections and extend the follow-up and retreatment intervals for longer duration. In contrast to previous studies on CRVO macular oedema such as CRUISE, COPERNICUS, GALILEO and SCORE2, which required six initial 4weekly loading anti-VEGF injections [8,10,11], the LEAVO Study performed only four initial injections at 4weekly intervals [7]. By giving four rather than six initial injections, the extent of visual acuity gain at 24 weeks in the aflibercept group was lower in the LEAVO Study (mean 13.4 letters) compared with COPERNICUS (mean 17.3 letters) and SCORE2 studies (mean 18.2 letters).…”

“…Despite the availability of these guidelines, the optimal treatment protocol regarding the choice of anti-VEGF agent and dosing regimen remains unclear. Recently, Hykin et al reported the outcomes of the LEAVO Study, which provided new insights and guidance on the choice of anti-VEGF agent for treating macular oedema due to CRVO [7]. This multi-centred randomised controlled noninferiority trial was funded by the UK National Institute for Health Research and the study objective was to evaluate the efficacy of three widely available intravitreal anti-VEGF agents namely ranibizumab, aflibercept and bevacizumab for macular oedema secondary to CRVO.…”

Comparison of vascular endothelial growth factor inhibitors on macular oedema secondary central retinal vein occlusion

“…The Lucentis, Eylea, Avastin in Vein Occlusion (LEAVO) study is the first trial to compare the outcomes of treatment of CRVO-related CMO with the three available VEGF inhibitors. This was a non-inferiority study that randomly assigned 463 patients into treatment with aflibercept, ranibizumab or bevacizumab [7]. The primary outcome showed that bevacizumab was not non-inferior compared with ranibizumab while aflibercept was non-inferior but not superior to ranibizumab.…”