COMMENTARY

Despite Significantly Different Pricing, Similar Efficacy for Key Anti-VEGF Agents in Macular Edema

Brianne N. Hobbs, OD

Disclosures

June 20, 2017

Effect of Bevacizumab vs Aflibercept on Visual Acuity Among Patients With Macular Edema Due to Central Retinal Vein Occlusion: The SCORE2 Randomized Clinical Trial

Scott IU, VanVeldhuisen PC, Ip MS, et al; SCORE2 Investigator Group
JAMA. 2017; 317:2072-2087

Study Summary

The goal of the multicenter clinical SCORE2 trial was to establish the safety and efficacy of bevacizumab compared with aflibercept in the treatment of macular edema secondary to central retinal vein occlusion (CRVO) or hemiretinal vein occlusion (HRVO).

Patients were randomly assigned to receive either 1.25 mg of bevacizumab (n = 182) or 2.0 mg of aflibercept (n = 180) every 4 weeks for 6 months. At baseline, patients had a mean visual acuity letter score of 50.3, corresponding to a Snellen visual acuity of 20/100. In contrast to some other trials, participants who received prior anti-vascular endothelial growth factor (VEGF) treatment (33.4%) were not disqualified from study participation, although a 2-month washout period was mandatory. On average, participants had been diagnosed with macular edema for 7 months at the time of enrollment.

This study was centered on establishing noninferiority of bevacizumab, using a five-letter noninferiority margin that, on the basis of previous trials, was thought to likely represent a true difference of visual function.

Early results from this trial seem to indicate that bevacizumab is as effective as aflibercept. At 6 months, the mean visual acuity letter score was 69.3 (Snellen equivalent of 20/40) in both treatment groups, thus fulfilling the criterion for noninferiority. Less than 2% of participants in each group lost more than 15 letters of acuity, which provided more evidence for the similar efficacy of bevacizumab and aflibercept. A similar proportion of participants in the bevacizumab (61.3%) and aflibercept (65.1%) groups gained 15 letters or more.

The safety of the two anti-VEGF agents was overall quite similar, but there was one subtle difference. Twice as many patients in the bevacizumab group had an intraocular pressure spike > 10 mm Hg compared with the aflibercept group, but overall, the occurrence was very low (9 patients vs 4 patients, respectively).

There was a significant difference between the two treatment groups in one important area: resolution of macular edema. In the aflibercept group, 54.4% had resolution of macular edema compared with only 28.5% in the bevacizumab group. Somewhat paradoxically, the resolution of macular edema did not affect visual acuity at 6 months, which was equivalent between the groups.

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