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    Aflibercept DME superiority diminishes in second year


    Additionally, they administered focal/grid laser photocoagulation treatment if DME persisted without continual improvement after 6 months of injections.

    Participants did not know which drug they were receiving until the primary results were published in February 2015. At that time, if the investigators considered it to be warranted, the study participant could switch anti-VEGF agents.

    After 2 years, 201 patients (90%) remained in the aflibercept group, 185 (85%) in the bevacizumab group, and 218 (88%) in the ranibizumab group. At that point, the aflibercept group had received a median of 15 injections, the bevacizumab had received 16, and the ranibizumab group had received 15.

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    Sixty-four percent of the bevacizumab group received laser treatment, compared to 41% of the aflibercept group and 52% of the ranibizumab group.

    On average, VA improved over the 2 years by 12.8 letters with aflibercept, 10.0 with bevacizumab, and 12.3 with ranibizumab. The difference was statistically significant (p = 0.02) for aflibercept versus bevacizumab, but not for aflibercept versus ranibizumab (p = 0.47) and not for ranibizumab versus bevacizumab (p = 0.11).

    Among patients with an initial VA of 20/50 or worse, improvement was 18.1 letters with aflibercept, 13.3 with bevacizumab, and 16.1 with ranibizumab. Once again, this difference was only statistically significant for aflibercept versus bevacizumab (p = 0.02).

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    With VA of 20/32 or 20/40, mean improvement at 2 years was 7.8 letters for aflibercept, 6.8 for bevacizumab, and 8.6 for ranibizumab, and none of these differences were statistically significant.

    These findings carried forward many of the trends from the previous year. At the 1-year follow-up, when VA was 20/32 to 20/40 at the start of the trial, vision improved on average almost 2 lines in all three treatment groups.

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    At the end of the first year, for participants whose VA was 20/50 or worse at the start of the trial, aflibercept improved vision on average almost 18.9 letters, bevacizumab 11.8 letters, and ranibizumab 14.2 letters, with a statistically significant difference between aflibercept and bevacizumab (p < 0.001) as well as between aflibercept and ranibizumab (p = 0.003), but not between ranibizumab and bevacizumab (p = 0.21).

    Averaging the results over the 2 years, aflibercept maintained its statistically significant superiority over the other 2 drugs.

    Central subfield thickness

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