Real Life Multicenter Comparison of 24-Month Outcomes of Anti-VEGF Therapy in Diabetic Macular Edema in Turkey: Ranibizumab vs. Aflibercept vs. Ranibizumab-Aflibercept Switch

The aim of this study was to compare the outcomes of diabetic macular edema (DME) treated with aflibercept (AFB) or ranibizumab (RNB) only, and after switching from RNB to AFB. This was a retrospective, real-world, multicenter (7 cities) 24 month study. Overall, 212 eyes in the AFB group, 461 in the RNB group, and 141 in the RNB to AFB group were included. The primary endpoints were differences in visual acuity (VA) and central macular thickness (CMT) from baseline to the final visit. The secondary outcomes were the percentage of eyes that achieved >= 10 letters gain and >= 10 letters loss in vision at month 12 and 24, and the percentage of eyes that achieved a thinning of >= 20% in CMT at month 3 and month 6. The results showed that VA did not significantly differ at baseline (AFB: 0.62 +/- 0.38, RNB: 0.61 +/- 0.36, RNB to AFB: 0.61 +/- 0.38), at checkpoints, or at the final visit (AFB: 0.46 +/- 0.38, RNB: 0.5 +/- 0.37, RNB to AFB: 0.53 +/- 0.36) (p > 0.05). Though the mean CMT at baseline was significantly thicker in the RNB to AFB group (479 +/- 129.6 mu m) when compared to the AFB (450.5 +/- 122.6 mu m) and RNB (442 +/- 116 mu m) groups (p < 0.01), similar measurements were obtained after 12 months. The percentages of eyes that gained or lost >= 10 letters in the AFB, RNB, and RNB to AFB groups at year 1 and 2 were similar, as was the percentages of eyes that demonstrated >= 20% CMT thinning at month 3 and 6. Our study showed similar visual improvements in non-switchers (AFB and RNB groups) and switchers (RNB to AFB group) through 2 years follow-up, however, AFB patients required fewer injections, visits, or need for additional treatments.