Three-year treatment outcomes of Aflibercept versus Ranibizumab for diabetic macular edema: data from the Fight Retinal Blindness! Registry

Purpose: Compare the three-year outcomes of ranibizumab versus aflibercept in eyes with DME in daily practice.

Methods: This was a retrospective analysis of naive DME eyes starting intravitreal injections of ranibizumab (0.5mg) or aflibercept (2mg) from 1 January 2013 to 31 December 2017 that were collected in the Fight Retinal Blindness! registry.

Results: We identified 534 eyes (ranibizumab – 267, aflibercept – 267) of 402 patients. The adjusted mean (95% CI) VA change of +1.3 (-0.1, 4.2) letters in the ranibizumab group and +2.4 (-0.2, 5.1) letters (P = 0.001) in the aflibercept group at 3 years was not clinically different. However, the adjusted mean CST change appeared to remain significantly different throughout the three-year period with higher reductions in favor of aflibercept (-87.8 [-108.3, -67.4] µm for ranibizumab vs. -114.4 [-134.4, -94.3] for aflibercept; P < 0.01). When baseline visual impairment was moderate (VA ≤68 ETDRS letters), we found a faster improvement in VA in eyes treated with aflibercept up until 18 months of treatment than eyes treated with ranibizumab, which then stayed similar until 36 months of treatment, while there was no apparent difference when baseline visual impairment was mild (VA ≥69 ETDRS letters). The rate of serious adverse events was low. Conclusions: Aflibercept and ranibizumab were both effective and safe for DME over 3 years.