Bevacizumab and Ranibizumab in the treatment of diabetic macular oedema: Can results from clinical trials be reproduced in the National Health Service?

Abstract

Purpose: To assess the reproducibility of clinical trials on the treatment of DMO with anti-VEGF modalities in the National Health Service in the United Kingdom.

Methods: A retrospective case note analysis of patients treated with Bevacizumab or Ranibizumab for DMO at two west London hospitals. Minimum 12month follow up. Treated between 2008-2012. Outcome measures: 1.Difference in ETDRS best-corrected visual acuity (BCVA) at Baseline and 12 months. 2.Mean change in BCVA 3.Proportion gaining at least 15 letters, 0-15 letters and 0-10 letters 4.Change in central macular thickness.

Results: 91 patients were treated with Bevacizumab and 15 with Ranibizumab that met the diagnostic and follow up inclusion criteria. The Bevacizumab group showed 7 EDTRS letter gain with a mean change in CMT of -104 µm. 70% of patients responded to treatment with 22% gaining ≥ 15 letters and 48.4% gaining between 0-10 letters. In the Ranibizumab group a 4 EDTRS letter gain with a mean change in CMT of -64 µm was obtained. 40% of patients responded to treatment with 13% gaining ≥ 15 letters and 27% gaining 0-10 letters. There were no adverse events reported in either group.

Conclusions: Although both anti-vegf modalities improved visual acuity the degree of improvement was inferior to that seen in the recently published clinical trials. In our study the results for Bevacizumab were superior to Ranibizumab.

Keywords: 498 diabetes • 585 macula/fovea