Central foveal thickness transiently increases after anti-VEGF switch in DME
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Patients treated for diabetic macular edema who were switched from aflibercept to ranibizumab experienced a transient increase in central foveal thickness.
“Eyes with DME switched from aflibercept to ranibizumab therapy demonstrate a transient increase in central foveal thickness at the first visit immediately post-switch. There were no significant changes in visual acuity on short-term follow-up,” study co-author Michael A. Klufas, MD, told Healio/OSN.
One hundred two eyes of 72 patients were included in the retrospective cohort study. All eyes received Eylea (aflibercept, Regeneron) for at least three consecutive visits for DME and were then switched to Lucentis (ranibizumab, Genentech). Researchers evaluated central foveal thickness, intraretinal fluid and visual acuity data at seven time points: three consecutive visits before the switch, a switch visit and three consecutive visits after the switch.
Mean central foveal thickness statistically significantly increased from the switch visit to the first post-switch visit. The mean central foveal thickness at the switch visit was 262 µm, which increased to 325 µm (P = .006). However, there was not a statistically significant difference in central foveal thickness at later post-switch visits when compared with the switch visit.
No significant changes in mean logMAR visual acuity were observed between the three visits before the switch, 0.43, 0.43 and 0.40, respectively, and the switch visit, 0.43. There were also no significant differences between the mean logMAR visual acuity at the three post-switch visits, 0.43, 0.38 and 0.41, respectively, when compared with the switch visit.
“I think both agents are excellent to treat diabetic macular edema, and this study provides evidence to guide expectations in event of switching medications used to treat DME,” Klufas said.
Perspective
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Mellen and colleagues present an interesting study spawned by instance of inflammatory issues with aflibercept.
In their study, they report the findings of patients transitioned to ranibizumab during this period, with no significant differences in vision or anatomy following the switch. The study, while interesting, had a population of significant treated patients with a large number of previous aflibercept injections and with vision of approximately 20/40 to 20/50. The study results can be partially explained by the prior treatment of the patients but also the short study duration that is reported.
Protocol T has shown that aflibercept is anatomically and visually superior to ranibizumab within the first year in patients with vision 20/50 or worse, and unfortunately the study did not evaluate a longer duration of treatment where significant differences might exist. In addition, a lack of a control arm limits the interpretation of the study results.
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Mellen PL, et al. Ophthalmic Surg Lasers Imaging Retina. 2020;doi:10.3928/23258160-20201202-03.
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