In the treatment of diabetic macular edema, monotherapy with aflibercept or step therapy with bevacizumab and aflibercept are often used. But which therapy has the edge?
Many secondary diseases can occur with diabetes – including the diabetic one Maculoedema (DME). DME is an accumulation of vascular fluids in the macula. In injection therapy come frequently VEGF Inhibitor how Aflibercept or Bevacizumab used to prevent new blood vessels from forming. However, it is still unclear how the relative effectiveness of monotherapy with aflibercept compares to treatment with initially bevacizumab followed by a switch to aflibercept if there is insufficient improvement in the eye condition.
158 looks
Researchers have now examined this more closely and their Results im New England Journal of Medicine published. They included 312 eyes, or 270 adult subjects, with DME and a visual acuity letter score of 24 to 96, on a scale of 0 to 100, with higher scores indicating better visual acuity. That Snellen equivalent would be at 20/320 to 20/50.
158 eyes received monotherapy with 2 mg intravenous aflibercept and 154 eyes received 1.25 mg bevacizumab intravenously. After 12 weeks, subjects in the bevacizumab group could also receive aflibercept if established criteria were met. Over a 2-year period, 70% of the eyes in the bevacizumab step therapy were switched to aflibercept. The mean improvement in visual acuity was 15 letters in the aflibercept monotherapy group and 14 letters in the bevacizumab group. The two therapies showed little difference: after 2 years, the mean changes in visual acuity and the thickness of the central subfield of the retina were similar in both groups.
However, serious adverse events occurred more frequently in the aflibercept monotherapy group in 52% of patients compared to bavacizumab step therapy (36%). It was similar for hospitalizations due to adverse events (48% vs. 32%).
Hardly any difference
“In this study of eyes with moderate visual loss due to diabetic macular edema in the center of the macula, we found no evidence of a significant difference in visual performance over 2 years in eyes treated with aflibercept monotherapy compared to eyes who were first treated with bevacizumab,” the authors conclude.
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