Efficacy of switching therapy to aflibercept for patients with persistent diabetic macular edema: a systematic review and meta-analysis

Abstract

Background: To evaluate functional and anatomical consequences of switching anti-vascular endothelial growth factor (anti-VEGF) therapy from bevacizumab and/or ranibizumab to aflibercept intravitreal injection for the treatment of persistent diabetic macular edema (DME).Methods: Analysis of switching treatment in patients with persistent DME was performed using a literature search across multiple databases (PubMed, Medline, EMBASE, Cochrane Library and Web of Science) prior to May 2019. Therapeutic effect parameters, including mean change of best-corrected visual acuity (BCVA) and central macular thickness (CMT), were extracted from baseline to different follow-up times post initial injections. The quality of studies was assessed with the Downs and Black checklist. Data pertaining to ocular and systemic safety adverse events (SAEs) were collected as well as subgroup analysis stratified by preswitch anti-VEGF reagents. All results were analyzed and pooled using random-effects models with 95% confidence intervals (CI).Results: Fourteen studies involving 489 eyes met the inclusion criteria. The mean differences in BCVA were significantly improved at 1, 2 and 3 months with −0.11 logMAR (P=0.016), −0.22 logMAR (P<0.001) and −0.24 logMAR (P<0.01), respectively. Vision gain was also assessed following the aflibercept injection with a mean change of −0.10 logMAR (P<0.001) at 6 months and −0.08 logMAR (P=0.01) at 12 months.CMT reduction was significant from baseline with a mean decrease of 80.52 μm (P<0.001) at 1 month, 89.6 μm (P<0.013) at 2 months, 113.88 μm (P<0.001) at 3 months and 125.12 μm (P<0.001) at 6 months.Mean CMT continued to decline by 75.70 μm (P<0.001) at 12 months as well.Conclusions: This meta-analysis indicated the comparable efficacy and safety of a conversion treatment to aflibercept in cases of unsatisfactory responses to other anti-VEGF drugs. Switching treatment produces significant advantage for vision acuity recovery and macular edema improvement among persistent DME patients.

The Change of Aqueous Humor Cytokine Levels after Anti-VEGF in Diabetic Macular Edema: A Systematic Review and Meta-Analysis

“…Vitreous or aqueous levels of VEGF are reportedly related to retinal vascular permeability and the severity of DME. Also, injections of anti-VEGF reagents have become the first-line treatment worldwide in DME patients [21]. Notably, our results demonstrated a decrease in VEGF and CMT.…”

Benefit Of Vitrectomy And Internal Limiting Membrane Peeling In The Treatment Of Resistant Diabetic Macular Edema

“…The most widely accepted priority treatment for DME today is injection of intravitreal anti-vascular endothelial growth factor (anti-VEGF) drugs (23). As the availability of more user-friendly microsurgical instruments and high incision speed devices increases, there is a tendency for surgical intervention to diabetic retinopathy and DME in earlier stage.…”

Intravitreal Aflibercept as a Rescue Therapy for Retinal Neovascularization and Macular Edema due to Eales Disease

“…In addition, aflibercept had faster association rate and higher binding affinity for VEGF than ranibizumab. Aflibercept thus may neutralize intravitreal VEGF level more effectively and had further positive effect on reduced inflammation [ 14 , 15 ].…”