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    Aflibercept fares well in treating DME

    Intravitreal aflibercept (Eylea, Regeneron Pharmaceuticals) was found to improve visual acuity outcomes in eyes with diabetic macular edema (DME), more so than intravitreal ranibizumab (Lucentis, Genentech), according to findings published in BMC Ophthalmology.

    Findings of the systematic review and mixed treatment comparison of aflibercept with other therapies for DME also reported that vascular endothelial growth factor (VEGF) inhibition with either aflibercept or ranibizumab is efficacious and appears safe. Aflibercept was associated with a trend toward fewer adverse ocular events compared with dexamethasone 0.7 mg implants.

    Researchers from France, the Netherlands, the United Kingdom,. and the United States undertook a comprehensive search to source relevant studies. They prepared feasibility networks to identify viable comparisons of 12-month outcomes between aflibercept and therapies licensed outside the United States, and then assessed them for clinical and statistical homogeneity.

    Pooled effect sizes (mean difference [MD] and relative risk/risk ratio [RR]) were calculated, using fixed- and random-effects models. Indirect comparisons were performed using Bucher analysis. If at least one head-to-head study was found, a mixed treatment comparison (MTC) was performed using Bayesian methods.

    Two 12-month comparisons could be undertaken based on indirect analyses: aflibercept (2 mg every 8 weeks after 5 initial monthly doses) versus ranibizumab (0.5 mg as needed) (10 studies) and aflibercept versus dexamethasone (three studies).

    The researchers found that there was an increase in mean best-corrected visual acuity (BCVA) with aflibercept over ranibizumab by 4.67 letters  in the fixed-effect MTC model (10 studies) and by 4.82 letters  in the Bucher indirect analysis (four studies). Aflibercept doubled the proportion of patients gaining ≥ 10 Early Treatment Diabetic Retinopathy Study (ETDRS) letters at 12 months compared with dexamethasone in the fixed-effect model. There were no significant differences in safety outcomes between aflibercept and ranibizumab or dexamethasone.

    The researchers concluded that studies of aflibercept showed improved 12-month visual acuity measures compared with studies of ranibizumab and dexamethasone based on indirect comparisons.

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