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Patients with DME show positive response after switching to aflibercept
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Switching to aflibercept in patients with diabetic macular edema who had a poor response to ranibizumab led to positive results in a prospective study.
Fifty eyes of 40 patients were analyzed. Previous Lucentis (ranibizumab, Genentech) treatment duration was 30 months on average, during which a mean of 21 injections had been administered. In the 6 months before the study, patients had received five or six injections. The results of Eylea (aflibercept, Bayer) were evaluated at 20 weeks, after the patients had received five monthly injections.
Positive results were obtained, with an average improvement of 0.06 log units of contrast sensitivity and 0.05 logMAR of best corrected visual acuity. Mean central retinal thickness decreased by 35 µm. More than half of the patients reported subjective improvement of vision-related quality of life.
According to the authors, the improved response of patients after the switch was due to the inherent properties of the aflibercept molecule, which differs structurally from both the antibody fragment ranibizumab and the monoclonal antibody bevacizumab. Aflibercept has a greater binding affinity to VEGF-A and also binds to VEGF-B and placental growth factor.
“It is reasonable to assume that these pharmacologic advantages of aflibercept are at least partially responsible for the data presented here,” the authors wrote.
A strength of this study was the inclusion of contrast sensitivity as a primary endpoint, first because of the strong association between diabetic retinopathy and contrast sensitivity loss due to the damage of retinal ganglion cells and second because of many visual tasks. “Assessing both VA and [contrast sensitivity] in clinical studies may provide a more complete picture of the effect of treatment on vison than either measure alone,” the authors wrote.
“The results of this study should encourage clinicians to reacquaint themselves with contrast sensitivity as an important component of visual function testing as it plays a significant role in the activities of daily living, such as driving, facial recognition and reading speed. Evidence from this paper shows that removing even small amounts of residual fluid in cases of diabetic macular edema can result in improvements in visual function, including contrast sensitivity,” Donald R. Nixon, MD, one of the two study authors, told Healio.com/OSN. “Switching anti-VEGF therapy in cases of DME with residual fluid, in this case going from ranibizumab to aflibercept, may be associated with a further reduction in fluid and a commensurate improvement in visual function. In the future, the evaluation of contrast sensitivity, as a part of overall workup for DME, may be used to guide us in the initiation and continuation of treatment for patients with diabetic macular edema.” – by Michela Cimberle
Disclosures: The authors report no relevant financial disclosures.
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