What is the role of VEGF inhibitors in the management of diabetic retinopathy?

Updated: Sep 02, 2021
  • Author: Abdhish R Bhavsar, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

In a DRCR.net clinical trial comparing Eylea (aflibercept), Lucentis (ranibizumab), and Avastin (bevacizumab) for diabetic macular edema (DME), aflibercept provided greater visual improvement, on average, than did the other 2 drugs for vision of 20/50 or worse at the start of the trial. The 3 drugs achieved similar average improvement for vision of 20/40 to 20/32. No major differences in safety were found for the 3 drugs. [36]

Investigators included 660 people with macular edema at 88 clinical trial sites across the US. Only people with vision of 20/32 or worse were eligible. About half the participants had 20/32 or 20/40 vision at time of enrollment, and the other half had vision of 20/50 or worse.

Participants were randomly assigned to receive aflibercept (2.0 mg/0.05 mL), bevacizumab (1.25 mg/0.05 mL), or ranibizumab (0.3 mg/0.05 mL) and were evaluated monthly. The drug was injected into the eye until the DME resolved or stabilized. Laser treatment was used if DME persisted without continual improvement after 6 months of injections.

Vision substantially improved for most participants at one year after the trial began. For people whose vision was 20/32 or 20/40 at the start of the trial, vision improved almost two lines on an eye chart in those receiving each of the 3 drugs. However, for those whose vision was 20/50 or worse at the start of the trial, aflibercept improved vision on average almost four lines, bevacizumab improved vision on average almost 2.5 lines, and ranibizumab improved vision on average almost 3 lines.


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