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Switching therapy from bevacizumab to aflibercept for the management of persistent diabetic macular edema

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the visual and anatomical outcomes following switching therapy from bevacizumab to aflibercept in patients with persistent diabetic macular edema (DME).

Methods

Patients with DME and central macular thickness (CMT) >300 μm on spectral domain optical coherence tomography (SD-OCT) despite at least 4 intravitreal bevacizumab injections in the prior 6 months were recruited for this prospective, single-armed, single centre, open-label clinical trial. Five loading doses of intravitreal aflibercept were administered every 4 weeks until week 16, at which point the treatment interval was extended to 8 weeks. All participants were reviewed every 4 weeks. At each visit, examination included best-corrected visual acuity (BCVA) measured with an Early Treatment of Diabetic Retinopathy Study chart and CMT measured with SD-OCT. Primary outcome measures were change in CMT and BCVA at week 24 compared with baseline.

Results

A total of 43 eyes from 43 patients were recruited for the study. At enrolment, study eyes had a mean ± standard deviation of 16.6 ± 11.5 previous intravitreal anti-VEGF injections over a period of 26.9 ± 23.8 months. Mean CMT reduced from 417 ± 91 μm at baseline to 380 ± 102 μm at 24 weeks (mean reduction 37 μm, p < 0.01). Mean BCVA improved from 67.8 ± 10.3 letters at baseline to 71.0 ± 10.1 letters at 24 weeks (mean 3.2 letter gain, p < 0.01). Eyes improving by ≥5 letters at 4 weeks following the first injection had improved vision outcomes at 24 weeks (6.8 ± 7.1 letters vs. 1.0 ± 4.7 letters, p < 0.01).

Conclusion

Intravitreal aflibercept was effective in improving anatomical and visual outcomes among patients with incomplete response to intravitreal bevacizumab with 24 weeks of follow up.

Clinical trial registration

ACTRN12614001307695

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Authors and Affiliations

  1. Sydney Institute of Vision Science, 13/187 Macquarie Street, Sydney, New South Wales, 2000, Australia

    Bobak Bahrami, Thomas Hong, Meidong Zhu & Andrew Chang

  2. Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia

    Bobak Bahrami & Andrew Chang

  3. Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia

    Timothy E. Schlub

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Correspondence to Andrew Chang.

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Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Funding

Bayer Corporation Global provided financial support in the form of an unrestricted grant. The sponsor had no role in the design, conduct or analysis of this research or in the preparation of the manuscript. None of the authors have any proprietary interest in any material or method presented.

Conflict of interest

Dr Andrew Chang has received research grant funding from Bayer. He has also acted as a consultant for Alcon, Bayer and Novartis. All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest, or non-financial interest in the subject matter or materials discussed in this manuscript.

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Bahrami, B., Hong, T., Zhu, M. et al. Switching therapy from bevacizumab to aflibercept for the management of persistent diabetic macular edema. Graefes Arch Clin Exp Ophthalmol 255, 1133–1140 (2017). https://doi.org/10.1007/s00417-017-3624-y

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  • DOI: https://doi.org/10.1007/s00417-017-3624-y

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