Comparative study of intravitreal ranibizumab and aflibercept for diabetic macular edema with ‘Treat and Extend’ algorithm

Abstract

Purpose : To compare the effectiveness of intravitreal ranibizumab (IVR) and aflibercept (IVA) for diabetic macular edema (DME) with ‘Treat and Extend’ (TAE) algorithm.

Methods : Fourteen eyes received 0.5 mg ranibizumab and 13 eyes received 2 mg aflibercept (mean age, 70.6±6.0 years for IVR and 66.9±8.2 years for IVA). After 3 consecutive monthly injections, the loading phase, eyes in both groups received additional injections with the TAE algorithm. Our TAE algorithm was: the baseline treatment interval was 8 weeks and was sequentially lengthened by 2 weeks if the central macular thickness (CMT) was <350 μm at 2 consecutive examinations. The changes in the best-corrected visual acuity (BCVA), CMT, and total number of injections from baseline to 18 months were evaluated.

Results : No significant differences were detected in the baseline demographics of the two groups. The BCVA was significantly improved for both the IVR and IVA groups; 0.28±0.19 to 0.13±0.18 logMAR units for IVR group and 0.38±0.21 to 0.11±0.11 logMAR units for the IVA group (P<0.01). The CMT was significantly reduced in both groups; 417.0±81.9 to 306.2±60.0 μm for IVR and 482.4±74.4 to 275.4±42.3 μm for the IVA group (P<0.01). No significant difference was observed between the groups. The total number injections was not significantly different between the two groups at 18 months (9.79±0.80 for IVR and 9.25±0.71 for IVA). But there was a significant difference between the two groups on the number of injections during the 8 to 10 weeks TAE period (6.54±1.05 for IVR and 5.64±1.43 for IVA; P<0.05).

Conclusions : The results showed that there was no significant differences between the two groups, and the TAE algorithm for both IVR and IVA were effective. IVA could extend the treatment interval much earlier than IVR treatment.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.