Diabetic Retinopathy: Which anti-VEGFs Are Most Effective?

The anti-vascular endothelial growth factor (anti-VEGF) treatments aflibercept, bevacizumab, and ranibizumab, for diabetic macular edema (DME) were associated with lower rates of diabetic retinopathy worsening, a recent study showed.

It is well known that anti-VEGF therapy for DME improves diabetic retinopathy and slows worsening. However, little data exists to show whether these effects differ across anti-VEGF agents.
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In a comparative effectiveness trial for center-involved DME, 650 participants of a mean age of 61 years were randomly assigned to receive 2.0 mg aflibercept (n = 141), 1.25 mg bevacizumab (n = 131), or 0.3 mg ranibizumab (n = 151), up to every 4 weeks through 2 years following a retreatment protocol.

Of 650 participants, 495 had nonproliferative diabetic retinopathy (NPDR), and 155 had proliferative diabetic retinopathy (PDR).

The researchers identified the main outcomes as percentages with retinopathy improvement at 1 and 2 years and cumulative probabilities for retinopathy worsening through 2 years, without adjustment for multiple outcomes.

Results showed that, among 423 NPDR eyes, 4 of 141 receiving aflibercept, 29 of 131 receiving bevacizumab, and 57 of 151 receiving ranibizumab had improved diabetic retinopathy severity at 1 year. Additionally, 33 eyes receiving aflibercept, 25 receiving bevacizumab, and 40 receiving ranibizumab had diabetic retinopathy improvement at 2 years.

After 1 year, improvement rates for 93 eyes with PDR at baseline were 75.9% for aflibercept, 31.4% for bevacizumab, and 55.2% for ranibizumab. These rates were maintained at 2 years as well.

“At 1 and 2 years, eyes with NPDR receiving anti-VEGF treatment for DME may experience improvement in [diabetic retinopathy] severity,” the researchers concluded. “Less improvement was demonstrated with bevacizumab at 1 year than with aflibercept or ranibizumab. Aflibercept was associated with more improvement at 1 and 2 years in the smaller subgroup of participants with PDR at baseline. All 3 anti-VEGF treatments were associated with low rates of [diabetic retinopathy] worsening. These data provide additional outcomes that might be considered when choosing an anti-VEGF agent to treat DME.”

—Christina Vogt

Reference:

Bressler SB, Liu D, Glassman AR, et al; Diabetic Research Network. Change in diabetic retinopathy through 2 years: secondary analysis of a randomized clinical trial comparing aflibercept, bevacizumab, and ranibizumab. JAMA Ophthalmol. 2017;135(6):558-568. doi:10.1001/jamaophthalmol.2017.0821.