Comparison of Efficacy of Intravitreal Aflibercept and Ranibizumab in Treatment-naive Diabetic Macular Edema

Abstract

This study was conducted at the İstanbul Okmeydanı Training and Research Hospital, Clinic of Ophthalmology. The study was approved by Clinical Research Ethics Committee of Okmeydanı Training and Research Hospital and adhered to the principles of the Declaration of Helsinki. Initially, medical records and Objective: The purpose of this study was to compare the efficacy of two different intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents in two treatmentnaive and statistically equal cohorts of diabetic macular edema patients. Methods: In this retrospective study, 81 eyes of 64 treatment-naive diabetic macular edema (DME) patients were enrolled. Patients were divided into two groups and both groups were treated [37 eyes with intravitreal 0.5 mg ranibizumab (IVR) and 44 eyes with intravitreal 2 mg aflibercept (IVA)] with three consecutive injections at intervals of one month. All patients underwent a detailed eye examination including optic coherence tomography and best corrected visual acuity (BCVA; Snellen), biomicroscopy, fundoscopy and applanation tonometry at preoperative, 1 st , 2 nd and 3 rd month. BCVA values were converted into logarithm of the minimum angle of resolution (logMAR) for statistical analyses. Data were evaluated with SPSS 25.0. Results: Mean BCVA (logMAR) increased from 0.58±0.28 to 0.43±0.29, 0.39±0.25 and 0.32±0.26 (p=0.001, p<0.001, p<0.001) in the IVR group and from 0.54±0.28 to 0.41±0.34, 0.43±0.39 and to 0.32±0.37 (p=0.004, p=0.023, p<0.001) in the IVA group. Mean central macular thickness (CMT) decreased from 406±82 µm to 345±65 µm (1 st month), 332±83 µm (2 nd month) and finally to 303±60 µm (3 rd month) (p<0.001) in the IVR group and from 415±88 µm to 328±79 µm, 297±54 µm and finally to 277±54 µm (p<0.001) in the IVA group, respectively. There was no significant difference between the groups in terms of BCVA (p>0.05). In the subgroup analysis, CMT gain in patients with moderate DME (CMT ≤385 µm) was found significantly better in the IVA group compared to the IVR group (1 st month: 36.9 vs. 83.6, 2 nd month: 36.2 vs. 106.3, 3 rd month: 3 nd 72.7 vs. 125.1; p<0.05). Conclusion: Both anti-VEGFs were equally effective in visual outcomes. Compared to ranibizumab, aflibercept has a rapid and superior therapeutic effect in anatomical results, especially in moderate DME cases.

Comparison of the efficacy of aflibercept and ranibizumab after a 3-month loading dose in patients with diabetic macular edema

“…In a retrospective study by Erden et al [23], BCVA changed from 0.54 (0.28) LogMAR pre-treatment to 0.32 (0.37) LogMAR after 3 months of 2mg IVA loading. The CMT of these patients decreased from 415 (88) µm pre-treatment to 277 (54) µm at the end of 3 months.…”

“…In a study by Erden et al [23], treatment-naive DME patients were separated into two groups and IVA was applied to one group and IVR to the other. At the end of 3 months, there was no statistically significant difference between IVA and IVR in terms of both BCVA gain and CMT decrease.…”