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Efficacy of anti-VEGF agents may vary in treatment of DME

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LAS VEGAS — Ranibizumab may benefit some diabetic macular edema patients who had little or no response to bevacizumab, a speaker said here.

“Ranibizumab and bevacizumab show similar efficacy in neovascular AMD, but I think there’s some anecdotal evidence in our clinics that perhaps they may not be similar in the treatment of DME, at least not in all patients,” Dante J. Pieramici, MD, said at the American Society of Retina Specialists meeting.

The REEF study, a prospective, single-center, open-label phase 1/2 trial, included 35 patients with DME who previously received at least two Avastin (bevacizumab, Genentech) 1.25-mg injections within a 6-week interval. Mean patient age was 65 years.

All patients then received three monthly injections of 0.5-mg Lucentis (ranibizumab, Genentech). Two patients who had central subfield thickness of less than 300 µm and no evidence of cystic edema were switched to as-needed 0.5-mg injection. All other patients still had persistent edema and were switched to 2 mg of ranibizumab.

Initially, 25 patients had no response to monthly bevacizumab injections and 10 patients had a partial response.

At 3 months after receiving 0.5-mg injections of ranibizumab, patients gained a mean six letters of visual acuity; they gained an additional four letters at 6 months after receiving 2-mg injections.

At 3 months with the 0.5-mg dose, the average reduction in central subfield thickness was 22%. An additional 12% average reduction was seen at 6 months with the 2-mg dose.

At 6 months, a complete response was seen in seven of 24 patients; however, 75% of patients had central subfield thickness or edema that required additional injections, Pieramici said.

Limitations of the study included small sample size and lack of adequate controls, Pieramici said. A phase 3 clinical trial is being planned.

• Disclosure: Pieramici is a consultant to Genentech, Alimera and QLT and has received honoraria from Genentech.