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    Aflibercept DME superiority diminishes in second year

     

    The mean change in central subfield thickness was greatest with aflibercept, with a drop of 172 µm by the end of the second year. This was better than the drop of 149 µm for ranibizumab and 126 µm for bevacizumab, with the differences between aflibercept and bevacizumab (p < 0.001) and ranibizumab (p = 0.08) statistically significant, but not between ranibizumab and bevacizumab (p = 0.001).

    Among patients with a baseline VA of 20/50 or worse, bevacizumab reduced central subfield thickness by 185 µm, which was more than ranibizumab’s 174 µm, though still not as much as aflibercept’s 211 µm.

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    In patients with VA of 20/32 to 20/40, on the other hand, bevacizumab only reduced central subfield thickness by 68 µm, versus 125 µm for ranibizumab and 133 µm for aflibercept.

    There were no statistically significant differences in the percentages of patients suffering adverse events among the groups. Elevated IOP was the most frequently reported complication.

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    In his own practice, Dr. Wells said, he still prefers aflibercept for patients with the weakest vision. “I would think clearly baseline vision is important. And if baseline vision were 20/50 or worse, I would choose [aflibercept],” he said. “It’s obviously more effective at 1 year, and even though the difference with ranibizumab is narrowed at the 2-year endpoint, you want to give people better vision as quickly as you can.”

    In eyes with better vision, he prefers ranibizumab because it is less expensive than aflibercept and because in these patients, it might reduce edema more than bevacizumab.

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    This article was adapted from Dr. Wells’ presentation during the 2016 meeting of the American Society of Retina Surgeons. Dr. Wells discloses grants and non-financial support from Genentech and Regeneron during the conduct of the study.

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