Abstract
Purpose :
While bevacizumab is commonly used first-line as anti-vascular endothelial growth factor (VEGF) therapy for patients with diabetic macular edema (DME), patients who fail to respond to bevacizumab may be switched to aflibercept therapy. We hypothesize that patients with DME who switched from bevacizumab to aflibercept at Los Angeles General Medical Center (LAGMC) will show improvements in central subfield thickness (CST) and best-corrected visual acuity (BCVA) over 12 months of follow-up.
Methods :
Medical records of patients with type II diabetes and diabetic macular edema who received anti-VEGF therapy with bevacizumab were retrospectively reviewed. Patients who switched from multiple treatments of bevacizumab to aflibercept (40 mg/mL) between 2018-2022 were included in the study. All eligible eyes were analyzed at baseline (before switching drugs) and at one-month, three-month, six-month, and 12-month intervals after switching drugs. Primary outcomes were BCVA and CST measurements obtained from optical coherence tomography (OCT) scans. Two-tailed t-tests were used for statistical analysis. The University of Southern California Institutional Review Board deemed this research exempt.
Results :
A total of 66 eyes from 59 patients were included in the study. At baseline, the mean BCVA was 0.6442 ± 0.3313 LogMAR and mean CST was 368.25 ± 129.20 µm. The mean number of aflibercept injections by 12 months was 6.39 ± 2.06. Mean BCVA improved to 0.6091 at one month (p=0.554), then worsened to 0.6516 at three months (p=0.997), 0.6451 at six months (p=0.927), and 0.6983 at 12 months (p=0.542). Mean CST decreased from baseline to 297.73 at one month (p=0.074), 278.44 at three months (p=0.013), 273.88 at six months (p=0.013), and 279.38 at 12 months (p=0.032).
Conclusions :
Our results indicate that in DME refractory to bevacizumab therapy, switching to aflibercept produces significant improvements in CST. Furthermore, most (66.67%) of patients experienced an improvement in BCVA at 12 months. These findings indicate the potential benefit of drug switching in patients who have not responded adequately to bevacizumab monotherapy.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.