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    Aflibercept DME superiority diminishes in second year

    Aflibercept remains superior to bevacizumab after 2 years of treating patients with poor baseline visual acuity (VA) caused by diabetic macular edema (DME), but it loses its edge over ranibizumab, researchers said.

    “Vision gains from baseline at 2 years were seen in all 3 groups with about half the number of injections, slightly decreased frequency of visits, and decreased amounts of laser in the second year,” said John A. Wells, MD, Palmetto Retina Center, Columbia, South Carolina.

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    Dr. Wells and his colleagues from the Diabetic Retinopathy Clinical Research Network (DRCR.net)  published the findings from the Protocol T trial in Ophthalmology.

    The results may help clinicians faced with the difficult choice between the 3 anti-vascular endothelial growth factor (VEGF) drugs approved for DME.

    Separately, all 3 drugs have shown impressive results in restoring or protecting vision in patients with DME, but their prices are very different. Based on Medicare allowable charges, the drugs at the doses used in this study cost about $1,960 for aflibercept (Eylea, Regeneron), $1,200 for ranibizumab (Lucentis, Genentech), and about $70 for bevacizumab (Avastin, Genentech) per injection, according to the National Eye Institute.

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    The DRCR.net investigators enrolled 660 people with DME at 88 sites across the United States. At baseline, the patients had a mean age of 61 years and had type 1 or type 2 diabetes for a mean of 17 years.

    The investigators restricted the trial to people with a VA of 20/32 or worse. At enrollment, about half of the participants had 20/32 to 20/40 vision, and the other half had 20/50 or worse vision.

    The researchers randomly divided the participants into thirds. One group received 2.0 mg/0.05 mL of aflibercept, one received 1.25 mg/0.05 mL of bevacizumab, and one received 0.3 mg/0.05 mL of ranibizumab.

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    Clinicians evaluated participants every 4 weeks during the first year and every 4 to 16 weeks during the second year, depending on treatment course. At each visit, they assessed the study eyes for retreatment with the anti-VEGF agent based on visual and optical coherence tomography (OCT) criteria. They administered intravitreal injections of the study drugs until the DME resolved or stabilized.

    VA improvement

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