Twelve-month outcomes of ranibizumab versus aflibercept for macular oedema in branch retinal vein occlusion: data from the FRB! registry

Abstract

Background/AimsTo compare the efficacy of ranibizumab (0.5 mg) with aflibercept (2 mg) in the treatment of cystoid macular oedema due to branch retinal vein occlusion (BRVO) over 12 months.MethodsA multicentre, international, database observational study recruited 322 eyes initiating therapy in real-world practice over 5 years. The main outcome measure was mean change in EDTRS letter scores of visual acuity (VA). Secondary outcomes included anatomic outcomes, percentage of eyes with VA >6/12 (70 letters), number of injections and visits, time to first inactivity, switching or non-completion.ResultsGeneralised mixed effect models demonstrated that mean (95% CI) adjusted 12-month VA changes for ranibizumab and aflibercept were similar (+10.8 (8.2 to 13.4) vs +10.9 (8.3 to 13.5) letters, respectively, p=0.59). The mean adjusted change in central subfield thickness (CST) was greater for aflibercept than ranibizumab (−170 (−153 to –187) µm vs −147 (−130 to –164) µm, respectively, p=0.001). The overall median (Q1, Q3) of 7 (4, 8) injections and 9 (7, 11) visits was similar between treatment groups. First grading of inactivity occurred sooner with aflibercept (p=0.01). Switching was more common from ranibizumab (37 eyes, 23%) than from aflibercept (17 eyes, 11%; p=0.002).ConclusionVisual outcomes at 12 months in this direct comparison of ranibizumab and aflibercept for BRVO in real-world practice were generally good and similar for the 2 drugs, despite a greater effect of aflibercept on CST and time to first grading of inactivity.

One‐year real‐world outcomes of bevacizumab for the treatment of macular oedema secondary to retinal vein occlusion

“…registry which were treated with either ranibizumab or aflibercept. 3 The mean change in VA from a similar mean baseline in this RWS (+10.9 letters) was comparable to that observed in the current study with a similar number of injections having been administered (median also seven). Similarly, the mean CST improvement for BRVO eyes in our study of À149 μm was within the range reported in the cohorts treated with aflibercept (À170 μm) or ranibizumab (À147 μm).…”

“…This hypothesis is supported by the recent analysis of eyes with BRVO in the FRB! registry which were treated with either ranibizumab or aflibercept 3 . The mean change in VA from a similar mean baseline in this RWS (+10.9 letters) was comparable to that observed in the current study with a similar number of injections having been administered (median also seven).…”

“…Australia contributed 67% of all eyes in the analysis that commenced bevacizumab treatment before January 2016 but only 23% of CRVO eyes and 30% of BRVO eyes after January 2016. The median (Q1, Q3) baseline VA and CST in Australian CRVO eyes was worse after January 2016 dropping from 43 (23,58) letters and 585 μm to 33 (3,45) letters and 845 μm. This suggests that many eyes in the Australian cohort commenced on bevacizumab after 2016 were those with worse CRVOs which did not fulfil the funding criteria for other anti-VEGF agents.…”

“…Bevacizumab is the only anti-VEGF agent that is on the WHO's list of essential medicines, 1 and whilst there is a growing body of real-world evidence supporting its use in neovascular macular degeneration and diabetic maculopathy, 2,3 there is a paucity of data on its effectiveness in retinal vein occlusion (RVO).…”

Recent Advancements in the Medical Treatment of Diabetic Retinal Disease

“…However, this study compared Faricimab against a low dose of ranibizumab (0.3 mg). In addition, it would be interesting to compare Faricimab with aflibercept, which has been shown to be more effective than ranibizumab in DME treatment [95]. The 1-year results of the ongoing 2-year YOSEMITE and RHINE multicenter, randomized trials showed promising results for faricimab in DME [96,97].…”