NIH Comparative Effectiveness Study in Diabetic Macular Edema published in the NEJM...
Aflibercept, Bevacizumab, or Ranibizumab for Diabetic Macular Edema
nejm.org
"In this comparative-effectiveness, randomized clinical trial of center-involved diabetic macular edema causing decreased visual acuity, treatment with intravitreous aflibercept, bevacizumab, or ranibizumab was associated with a substantial improvement in mean visual acuity by 1 month, with the improvement sustained through 1 year with the use of a standardized retreatment protocol. On average, greater improvement was seen with aflibercept than with the other agents, although the magnitude of the greater effect of aflibercept lacked clinical applicability because it was dependent on initial visual acuity. When initial vision loss was mild (20/32 to 20/40, representing 51% of study eyes), there was little difference in mean visual acuity at 1 year among the three agents. At worse initial levels of vision, aflibercept had a clinically meaningful advantage; for example, an improvement in the visual-acuity letter score of at least 15 (3 Snellen lines) was observed in 63% more aflibercept-treated eyes than bevacizumab-treated eyes (67% vs. 41%) and in 34% more aflibercept-treated eyes than ranibizumab-treated eyes (67% vs. 50%). The effect of bevacizumab on reducing macular edema was less than that of the other two agents in both initial-visual-acuity subgroups. Irrespective of initial visual acuity, few eyes treated with any one agent had substantial loss of visual acuity."
Outstanding results in my view. |
