Short-Term Effects of Early Switching to Ranibizumab or Aflibercept in Diabetic Macular Edema Cases With Non-Response to Bevacizumab

Ashraf, Muhammad; Souka, Ahmed; Elkayal, Hassan

doi:10.3928/23258160-20170301-06

Cited by 27 publications

(19 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Following the same pattern, more eyes had an increase of more than 15 letters in the ranibizumab group compared with the aflibercept group. Similar outcomes have been already described by Ashraf et al 13 who reported that despite a significant CFT decrease after the switch to ranibizumab or aflibercept in eyes with DME refractory to bevacizumab, a significant improvement in BCVA was observed only with ranibizumab but not with aflibercept. As it is already well established, there is an association between DRIL, increasing severity of diabetic retinopathy, and a poor VA outcome with treatment.…”

Section: Discussionsupporting

confidence: 89%

“…[10][11][12] Much less evidence exists on the real efficacy differences between aflibercept versus ranibizumab treatment after an initial bevacizumab regimen. 13 Retinal edema is responsible for retinal microstructural changes, retinal atrophy of photoreceptors and ganglion cell lesions. 14 It may also be considered consensual that the best improvements in visual acuity are achieved when retinal edema is resolved.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Pessoa¹,

Malheiro²,

Carneiro³

et al. 2021

OPTH

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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

Pessoa¹,

Malheiro²,

Carneiro³

et al. 2021

OPTH

View full text Add to dashboard Cite

show abstract

“…Ashraf et al [339] performed a retrospective study of 59 eyes from 45 patients with DMO that were treated with bevacizumab, and were, per the Protocol T definition, classed as non-responders, and were switched to aflibercept or ranibizumab. BCVA significantly improved in eyes switched to ranibizumab, and significant decreases in CST were observed in both the ranibizumab and aflibercepttreated eyes.…”

Section: Evidence Reviewmentioning

confidence: 99%

Diabetic retinopathy and diabetic macular oedema pathways and management: UK Consensus Working Group

Amoaku

Ghanchi

Bailey

et al. 2020

Eye

125

121

View full text Add to dashboard Cite

The management of diabetic retinopathy (DR) has evolved considerably over the past decade, with the availability of new technologies (diagnostic and therapeutic). As such, the existing Royal College of Ophthalmologists DR Guidelines (2013) are outdated, and to the best of our knowledge are not under revision at present. Furthermore, there are no other UK guidelines covering all available treatments, and there seems to be significant variation around the UK in the management of diabetic macular oedema (DMO). This manuscript provides a summary of reviews the pathogenesis of DR and DMO, including role of vascular endothelial growth factor (VEGF) and non-VEGF cytokines, clinical grading/classification of DMO vis a vis current terminology (of centre-involving [CI-DMO], or non-centre involving [nCI-DMO], systemic risks and their management). The excellent UK DR Screening (DRS) service has continued to evolve and remains world-leading. However, challenges remain, as there are significant variations in equipment used, and reproducible standards of DMO screening nationally. The interphase between DRS and the hospital eye service can only be strengthened with further improvements. The role of modern technology including optical coherence tomography (OCT) and wide-field imaging, and working practices including virtual clinics and their potential in increasing clinic capacity and improving patient experiences and outcomes are discussed. Similarly, potential roles of home monitoring in diabetic eyes in the future are explored. The role of pharmacological (intravitreal injections [IVT] of anti-VEGFs and steroids) and laser therapies are summarised. Generally, IVT anti-VEGF are offered as first line pharmacologic therapy. As requirements of diabetic patients in particular patient groups may vary, including pregnant women, children, and persons with learning difficulties, it is important that DR management is personalised in such particular patient groups. First choice therapy needs to be individualised in these cases and may be intravitreal steroids rather than the standard choice of anti-VEGF agents. Some of these, but not all, are discussed in this document.

show abstract

“…Several studies have evaluated the effects of switching anti-VEGF agents on DME outcomes. [16][17][18][19][20][21][22] Prior studies showed that anatomic outcomes improved after switching, but they varied in their conclusions regarding VA, 18 with some reporting no improvements in VA 22 and others finding significant improvement. [16][17][18][19][20][21] Our study demonstrated a statistically significant decrease in CST, but the BCVA improvement was not significant at 12 months across the entire cohort.…”

Section: Discussionmentioning

confidence: 99%

Diabetic Macular Edema Treated With Intravitreal Aflibercept Injection After Treatment With Other Anti-VEGF Agents (SWAP-TWO Study)—12-Month Analysis

Golshani

Conti

et al. 2020

Journal of VitreoRetinal Diseases

View full text Add to dashboard Cite

Purpose: This article reports 12-month outcomes of patients with diabetic macular edema previously treated with other antivascular endothelial growth factor agents and transitioned to fixed dosing of intravitreal aflibercept (IAI). Methods: This prospective, single-arm study enrolled patients to receive IAI 2 mg (0.05 mL) every 4 weeks until optical coherence tomography demonstrated no fluid. Patients then received fixed dosing of IAI 2 mg once every 8 weeks through 12 months. Primary outcome was mean absolute change from baseline central subfield thickness (CST) at 12 months measured by optical coherence tomography. Results: Twenty eyes were enrolled. At baseline, best-corrected visual acuity was 70.0 letters, mean CST was 419.7 µm ± 92.0, superficial capillary perfusion density (CPD) was 46.0 ± 4.2%, and deep CPD was 50.8 ± 4.3%. At 12 months, the mean CST improved to 287.2 µm ± 80.2 ( P < .001), superficial CPD decreased to 43.6 ± 4.8% ( P = .04), and deep CPD decreased to 47.6 ± 4.8% ( P = .05). Conclusions: Patients who switched to fixed dosing of IAI demonstrated significant anatomic improvements in CST at 12 months. CPD values decreased significantly both in superficial and deep layers without significant changes in vision.

show abstract

Short-Term Effects of Early Switching to Ranibizumab or Aflibercept in Diabetic Macular Edema Cases With Non-Response to Bevacizumab

Abstract: Aflibercept and ranibizumab both appear to be effective for patients showing no initial response to bevacizumab. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:230-236.].

Cited by 27 publications

References 38 publications

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

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

Diabetic retinopathy and diabetic macular oedema pathways and management: UK Consensus Working Group

Diabetic Macular Edema Treated With Intravitreal Aflibercept Injection After Treatment With Other Anti-VEGF Agents (SWAP-TWO Study)—12-Month Analysis

Contact Info

Product

Resources

About