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Switching to Aflibercept Shows Mixed Results for Persistent Diabetic Macular Edema

A team from Philadelphia set out to uncover visual outcomes associated with switching to aflibercept from bevacizumab or ranibizumab.

Bevacizumab and ranibizumab are two treatment options for patients with diabetic macular edema (DME). However, if neither of these anti-vascular endothelial growth factor (VEGF) drugs work, aflibercept is also a therapy option. A team from Philadelphia set out to uncover visual outcomes associated with switching to aflibercept from one of the other treatments.

The researchers only looked at eyes that had been treated with at least four consecutive injections of either bevacizumab or ranibizumab (four to six weeks apart before switching therapies) and at least two aflibercept injections. The results were revealed at the 34th Annual Scientific Meeting of the American Society of Retina Specialists (ASRS 2016) in San Francisco, California.

A total of 50 eyes with DME from 37 patients with an average age of 70 were analyzed. The average bevacizumab or ranibizumab injection count was 13.7, and once patients switched therapies, an average of 4.1 aflibercept injections were recorded during the 4.6 months.

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At baseline, logMAR visual acuity was 0.60 (Snellen 20.80), which improved to 0.55 (Snellen 20/70) by the second visit after switching to aflibercept. Central macular thickness averaged at 459.2 µm at baseline and significantly improved to 348.7 µm by the second visit after switching treatments — a mean decrease of 112 µm. Additional data showed the mean intraocular pressure (IOP) started at 15.1 mmHg and decreased to 14.9 mmHg by the second visit.

Although the results showed significant anatomical improvements, the authors warned, “While trends towards improved visual acuity and reduction in IOP were observed, these were not statistically significant.”

Therefore, the takeaway message is that people with persistent DME can experience significant anatomical improvements with bevacizumab or ranibizumab history if they switch to aflibercept; however, there may not be noticeable improvements in visual acuity.

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