Switching to Aflibercept from Ranibizumab Improved DME Outcomes

Giuliana Silvestri, MD, FRCPEd, FRCOphth, FRCSEd

A small study showed that patients with diabetic macular edema (DME) who switched from ranibizumab injections to aflibercept injections had an average improvement in Best Corrected Distance Acuity (BCDA) of over 5 letters.

The poster was presented at the 2018 American Academy of Ophthalmology Annual Meeting in Chicago, IL.

“Patients with DME who were switched from ranibizumab to aflibercept showed an average improvement in BCDA of 5.7 (range -2 to 27) letters at 9-12 months,” wrote poster author Giuliana Silvestri, MD, FRCPEd, FRCOphth, FRCSEd, Macular Service Group, Belfast Health & Social Care Trust, UK.

The study included 70 patients (98 eyes) who had been switched from ranibizumab to aflibercept and had a minimum of 6 injections with 9-12 months of follow-up aflibercept. Reasons for switching included persistent fluid (91%), high injection frequency (6%), and recurrence of diabetic macular edema. More patients had type 2 diabetes (89%) than type 1 diabetes (11%).

Data were collected at baseline, at switching, after 3 loading doses, at 6 months, and at 9-12 months. Measurements of response included BCDA and anatomical response defined as complete, partial, or non-responder as measured by Center Foveal Thickness (CFT). Responder status was defined as complete for those completely dry after loading, partial for >10% reduction in optical coherence tomography thickness, and poor for <10% reduction in optical coherence tomography thickness.

Participants had a mean age of 68 years and the mean BCDA at switching was 66 (ranging from 55 to 80) letters. Mean BCDA at 3 and 6 months was 70 (range 59-85) letters and 69 (range 61-83) letters, respectively. At 9-12 months, the mean BCDA achieved was 72 (range 65-83).

Center Foveal Thickness was 437 μm (232-941 μm) at switching and 346 μm (170-804 μm) after loading. Nearly half of participants were partial responders (48%) while 36% were poor responders, and just 16% were complete responders.

Silvestri disclosed financial ties to Allergan, Bayer Healthcare Pharmaceuticals, and Novartis Pharma AG.

The poster, “Outcomes in patients with Diabetic Macular Edema Switched from Ranibizumab to Aflibercept,” was presented at the 2018 American Academy of Ophthalmology Annual Meeting in Chicago, IL.