Aflibercept, Ranbizumab Shown To Improve Visual Acuity in Eyes with CRVO

Adrian Hunt, MBBS

Although treatment of central retinal vein occlusion (CRVO) has shifted toward vascular endothelial growth factor (VEGF) inhibitors, there is limited data showing significantly improved vision in routine clinical care.

A team of investigators, led by Adrian Hunt, MBBS, The Save Sight Institute, Sydney Medical School, University of Sydney, aimed to compare 12-month treatment outcomes of aflibercept or ranibizumab for macular edema secondary to central retinal vein occlusion (CRVO) in routine clinical care.

The team observed both agents, aflibercept and ranibizumab, improved visual acuity (VA) and reduced central subfield thickness (CST) in eyes with CRVO in routine clinical practice.

Methods

Investigators performed a retrospective analysis of eyes with CRVO treated with intravitreal anti-VEGF agents. The patients were considered treatment-naive and managed at clinics in Australia, France, Switzerland, and the United Kingdom.

At each clinical visit, data was collected including the number of letters read on a logarithm of the minimum angle of resolution (logMAR) VA Chart, the active of cystoid macular edema, CST measured using spectral-domain optical coherence tomography (OCT), and treatment given.

Additionally, information on treatment-naive eyes that started treatment with ranibizumab or aflibercept for macular edema secondary to CRVO were recruited from centers using the prospectively designed Fight Retinal Blindness (FRB) Registry.

The primary outcome was the mean change in VA at 12 months between anti-VEGF agents, while secondary outcomes included mean changes in CST, injections and visits, time to first grading of inactivity, switching and non-completion from baseline to 12 months.

Results

In identification of participants, investigators found 296 treatment-naive patient eyes (125 ranibizumab and 171 aflibercept) in 291 patients with cystoid macular edema secondary to CRVO. Patients started treatment from June 2014 - June 2019.

Additionally, investigators noted baseline VA had slight improvement in aflibercept versus ranibizumab treated eyes (42.5 ± 25.5 letters versus 36.9 ± 26 letters; P = .07).

Data show the mean crude VA improvement was higher for aflibercept versus ranibizumab (+13.1 letters versus +9.9, P = 0.26).

Moreover, data also show the 12-month adjusted mean VA change was +16.6 (95% CI, 12.9 - 20.4) letters for aflibercept in comparison to +9.8 (95% CI, 5.5 - 14.1) letters for ranibizumab, all P = .001).

Further, investigators found a similar CST (614 μm versus 616 μm, P = .95), but at 12 months, the mean CST was significantly lower in the aflibercept group compared to the ranibizumab group (313 μm versus 370 μm).

In eyes presenting with poor VA, the mean adjusted change in CST had significantly greater changes in aflibercept versus ranibizumab-treated eyes (304 μm versus 252 μm, P <.001).

In addition, both groups had a median of 7 injections and 10 visits. Investigators noted aflibercept-treated eyes received some more injections, but was not considered statistically significant.

Further, the cox-proportional hazards model predicted aflibercept (9 eyes, 5%) became inactive at a quicker pace than ranibizumab (26 eyes, 21%), all P <.001.

Takeaways

Ultimately, investigators noted that eyes receiving aflibercept had larger visual gains and reductions in CST.

“The combination of stronger and potentially longer VEGF suppression of aflibercept may be one of the main drivers for better clinical outcomes since the more prolonged suppression may compensate for the somewhat lower number of injections,” investigators wrote.

The study, “12-month outcomes of ranibizumab versus aflibercept for macular oedema in central retinal vein occlusion: data from the FRB Registry,” was published in Acta Ophthalmologica.