Early Conversion to Aflibercept for Persistent Diabetic Macular Edema Results in Better Visual Outcomes and Lower Treatment Costs

Abstract

To evaluate the functional and anatomic outcomes, as well as cost-effectiveness, of the timing of conversion to intravitreal aflibercept (IVA) in patients with treatmentresistant diabetic macular edema (DME). Methods: Thirty consecutive eyes (25 patients) were identified that were treated with ≥3 intravitreal bevacizumab (IVB) and/or ranibizumab (IVR) injections prior to treatment with ≥3 IVA injections. Eyes that received ≤6 IVB and/or IVR injections (earlyswitch) were compared to those that received ≥7 injections (late-switch) prior to conversion to IVA. Treatment effectiveness was measured in quality-adjusted life years (QALYs). A micro-simulation model examined the impact of treatment duration on outcomes. Results: Early-(n=18) and late-(n=12) switch eyes had similar vision prior to conversion to IVA. Despite improvements in retinal thickness, only the early-switch eyes maintained vision gains after conversion to IVA through the end of follow-up (p=0.027). Early switch saved $22,884/eye and produced an additional 0.027 QALYs. Conclusion:Early conversion to IVA optimizes vision outcomes and results in lower overall treatment expenditures.

Optical Coherence Tomography Angiography Biomarkers Predict Anatomical Response to Bevacizumab in Diabetic Macular Edema

“…In certain cases, this information might lead to initiating a different form of treatment or even a decision to forgo treatment altogether in certain patients for whom the burden of injections and their costs outweigh the expected visual gains. 9 …”

“…6,-8 However, not all patients with DME respond equally well to anti-VEGF injections, and some agents are costlier than others. [6][7][8][9] Identifying which patients are at risk of a delayed or poor response to treatment may help manage treatment expectations and prepare clinicians for the need to consider alternative therapies. [9][10][11] Optical coherence tomography (OCT) imaging has been used to identify several biomarkers proposed as being predictive of a functional and anatomical response of patients with DME to anti-VEGF treatment, including the presence of disorganization of the inner layers of the retina 12 and the morphological pattern of DME.…”

“…[6][7][8][9] Identifying which patients are at risk of a delayed or poor response to treatment may help manage treatment expectations and prepare clinicians for the need to consider alternative therapies. [9][10][11] Optical coherence tomography (OCT) imaging has been used to identify several biomarkers proposed as being predictive of a functional and anatomical response of patients with DME to anti-VEGF treatment, including the presence of disorganization of the inner layers of the retina 12 and the morphological pattern of DME. 13 Optical coherence tomography angiography (OCTA) is a relatively new extension of OCT that generates non-invasive, depth-resolved images of the retinal microvasculature.…”

“… 6–9 Identifying which patients are at risk of a delayed or poor response to treatment may help manage treatment expectations and prepare clinicians for the need to consider alternative therapies. 9–11 …”

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

“…Also, many clinical studies are showing that aflibercept is superior to the other two anti-VEGF agents in the treatment of DME. 8,11,14–17,21–24 It is reported that aflibercept may have better bioavailability and efficacy due to its higher binding affinity to VEGF-A and better binding to VEGF-B and placental growth factor (PIGF). 25…”