Comparison of aflibercept and ranibizumab in diabetic macular edema associated with subretinal detachment

Abstract

Purpose: To compare the efficacy of ranibizumab and aflibercept in the treatment of diabetic macular edema associated with subfoveal retinal detachment. Methods: This is a retrospective, comparative study. The treatment-naïve diabetic macular edema patients who had diabetic macular edema associated with subfoveal retinal detachment and underwent intravitreal aflibercept or intravitreal ranibizumab treatment were included. The patients were treated on a pro re nata treatment regimen after a loading dose of 3-monthly injections and the follow-up time was 12 months. The primary outcome measure of this study was the presence of subfoveal retinal detachment after treatment at different time points. The secondary outcome measures were the change in best corrected visual acuity and central retinal thickness. Results: A total of 46 eyes of 46 patients were included. The aflibercept group consisted of 20 and the ranibizumab group consisted of 26 eyes. During the follow-up period of 12 months, subfoveal retinal detachment was completely resolved in 75% versus 57.7% of the eyes at month 3 (p = 0.2), 90% versus 76.9% at month 6 (p = 0.2), 90% versus 65.4% at month 9 (p = 0.05), and 100% versus 80.8% at month 12 (p = 0.03) in the intravitreal aflibercept versus intravitreal ranibizumab groups. The change in best corrected visual acuity was not statistically different between the groups at months 3, 6, 9, and 12, respectively (p > 0.05 for all). Conclusion: Both intravitreal aflibercept and intravitreal ranibizumab were effective in regards to anatomical and functional outcomes of diabetic macular edema patients associated with subfoveal retinal detachment. Interestingly, intravitreal aflibercept seemed more effective than intravitreal ranibizumab in the resolution of subfoveal retinal detachment at month 12.

Clinical Comparative Study of Intravitreal Injection of Triamcinolone Acetonide and Aflibercept in the Treatment of Diabetic Retinopathy Cystoid Macular Edema

“…The former may cause complications such as vision loss or visual field defect, while the latter injection of drugs such as glucocorticoid triamcinolone acetonide has certain curative effects, but it also has many adverse reactions. Aflibercept has been used well in recent years, and comparative studies with ranibizumab are more common [ 12 , 13 ], while the comparative analysis of efficacy with triamcinolone acetonide is immature. Based on this background, the purpose of this study was to compare and analyze the efficacy of the two in the treatment of cystic macular edema, in order to contribute reasonable suggestions for the clinical treatment of DR patients.…”

VEGFR1 signaling in retinal angiogenesis and microinflammation

“…The target specificity of currently used anti-VEGF drugs might also yield some hints about the pathobiological function of VEGFR1 in DR. There are numerous studies in DME patients showing significant differences between ranibizumab and aflibercept when looking at certain clinical readouts, with aflibercept showing higher efficacy or longer lasting treatment effects ( Bhandari et al, 2020 ; Jampol et al, 2016 ; Kaldirim et al, 2019 ; Ozkaya et al, 2020 ; Sarda et al, 2020 ; Shimizu et al, 2017 ). Furthermore, comparisons between aflibercept and bevacizumab * had similar outcomes ( American Academy of Opthalmology, 2019 ; Virgili et al, 2018 ; Wells et al, 2015 ; Wells et al, 2016 ).…”

Efficacy and Safety of Aflibercept Therapy for Diabetic Macular Edema

“…Two studies were not included in the analyses due to missing standard deviation data; however, these studies reported no significant difference in BCVA improvement between aflibercept and ranibizumab at 12 months ( P = 0.237 20 and P = 0.8). 21 Of the six studies, two RCTs demonstrated that the overall 1-year improvement in BCVA was significantly better with aflibercept (WMD = 2.19 ETDRS letters; 95% CI: 0.25–4.12 ETDRS letters; P = 0.027, I 2 = 0.0%) [ Figure 9 ] and four non-RCTs demonstrated a 1-year improvement in BCVA which was nonsignificantly better with aflibercept compared with ranibizumab (WMD = 1.53 ETDRS letters; 95% CI: –0.05–3.11 ETDRS letters; P = 0.058, I 2 = 21.5%) [ Figure 9 ]. At 2 years, visual outcomes related to aflibercept were no longer found to be superior to ranibizumab (WMD = 1.66 ETDRS letters, 95% CI: –0.15–3.48 ETDRS letters, P = 0.072, I 2 = 48.3%) [ Figure 8 ].…”

“…displayed similar results at 1 year ( P = 0.3). 21 Of the six studies, two RCTs demonstrated a nonsignificantly increased reduction in CMT with aflibercept compared to ranibizumab (WMD = −21.55 μm, 95% CI = −44.02–0.92 μm, P = 0.060, I 2 = 0.0%) [ Figure 13 ]. Four non-RCTs demonstrated a nonsignificantly increased reduction in CMT with aflibercept compared to ranibizumab (WMD = −10.12 μm, 95% CI = −51.71–31.47 μm, P = 0.633, I 2 = 83.6%) [ Figure 13 ].…”

“…Twenty-four studies commented on safety outcomes, including 14 studies reporting ocular adverse events 5 17 18 19 23 24 25 26 27 28 29 30 31 32 and 10 reporting no ocular adverse events with aflibercept. 15 16 20 21 22 33 34 35 36 37 The most commonly reported ocular adverse event was subconjunctival hemorrhage (164 cases of 2516 aflibercept-treated eyes with ocular safety data available, representing a prevalence of 6.5%). 24 26 27 30 31 32 Twelve studies reported APTC-defined adverse events with aflibercept treatment.…”