To evaluate the efficacy of switching from bevacizumab to ranibizumab in patients with diabetic macular edema (DME).
Methods
This was a retrospective study of patients with DME initially treated with bevacizumab and switched to ranibizumab. Visual acuity (VA) and central retinal thickness (CRT) were retrieved at fixed timepoints prior to and after the switch.
Results
Forty eyes of 32 patients were included in the study. The difference in VA between any of these fixed timepoints was not statistically significant. A significant gain in VA was found in eyes that lost more than 0.1 logMAR during treatment with the last 3 bevacizumab injections. The mean CRT was significantly lower after the first 3 ranibizumab injections and at the final follow-up (p<0.001), a 67 ± 14 μm and 78 ± 18 μm reduction in thickness, respectively.
Conclusions
Switching to ranibizumab resulted in a significant decrease in the CRT of eyes with DME, and should be considered when there is a lack of response or deterioration while on bevacizumab injections. A significant gain in VA was observed in a subgroup of eyes that lost more than one line while receiving the last 3 bevacizumab injections prior to the switch.
LangGEBertaAEldemBMet al.RESTORE Extension Study Group.Two-year safety and efficacy of ranibizumab 0.5 mg in diabetic macular edema: interim analysis of the RESTORE extension study. Ophthalmology2013;120(10):2004–2012
2.
BrownDMNguyenQDMarcusDMet al.RIDE and RISE Research Group.Long-term outcomes of ranibizumab therapy for diabetic macular edema: the 36-month results from two phase III trials: RISE and RIDE. Ophthalmology2013;120(10):2013–2022
3.
ElmanMJQinHAielloLPet al.Diabetic Retinopathy Clinical Research Network.Intravitreal ranibizumab for diabetic macular edema with prompt versus deferred laser treatment: three-year randomized trial results. Ophthalmology2012;119(11):2312–2318
4.
NguyenQDBrownDMMarcusDMet al.RISE and RIDE Research Group.Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology2012;119(4):789–801
5.
RajendramRFraser-BellSKainesAet al.A 2-year prospective randomized controlled trial of intravitreal bevacizumab or laser therapy (BOLT) in the management of diabetic macular edema: 24-month data: report 3.Arch Ophthalmol2012;130(8):972–979
6.
KriechbaumKPragerSMylonasGet al.Diabetic Retinopathy Research Group.Intravitreal bevacizumab (Avastin) versus triamcinolone (Volon A) for treatment of diabetic macular edema: one-year results. Eye (Lond)2014;28(1):9–15quiz 16.
7.
ArevaloJFLasaveAFWuLet al.Pan-American Collaborative Retina Study Group (PACORES). Intravitreal bevacizumab plus grid laser photocoagulation or intravitreal bevacizumab or grid laser photocoagulation for diffuse diabetic macular edema: results of the Pan-american Collaborative Retina Study Group at 24 months.Retina2013;33(2):403–413
8.
SoheilianMGarfamiKHRamezaniAYaseriMPeymanGATwo-year results of a randomized trial of intravitreal bevacizumab alone or combined with triamcinolone versus laser in diabetic macular edema.Retina2012;32(2):314–321
9.
Diabetic Retinopathy Clinical Research Network, Wells JA, Glassman AR, Ayala AR, Jampol LM, Aiello LP et al. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema.N Engl J Med2015;372(13):1193–203
10.
NepomucenoABTakakiEPaes de AlmeidaFPet al.A prospective randomized trial of intravitreal bevacizumab versus ranibizumab for the management of diabetic macular edema.Am J Ophthalmol2013;156(3):502–10.e2
11.
OllendorfDAColbyJAPearsonSDComparative effectiveness of anti-VEGF agents for diabetic macular edema.Int J Technol Assess Health Care2013;29(4):392–401
12.
FordJAEldersAShyangdanDRoylePWaughNThe relative clinical effectiveness of ranibizumab and bevacizumab in diabetic macular oedema: an indirect comparison in a systematic review.BMJ2012;345:e5182
13.
OzturkBTKerimogluHBozkurtBOkudanSComparison of intravitreal bevacizumab and ranibizumab treatment for diabetic macular edema.J Ocul Pharmacol Ther2011;27(4):373–377
14.
MartinDFMaguireMGYingGSGrunwaldJEFineSLJaffeGJCATT Research Group.Ranibizumab and bevacizumab for neovascular age-related macular degeneration. N Engl J Med2011;364(20):1897–1908
15.
ChakravarthyUHardingSPRogersCAet al.IVAN Study Investigators.Ranibizumab versus bevacizumab to treat neovascular age-related macular degeneration: one-year findings from the IVAN randomized trial. Ophthalmology2012;119(7):1399–1411
16.
KrebsISchmettererLBoltzAet al.MANTA Research Group.A randomised double-masked trial comparing the visual outcome after treatment with ranibizumab or bevacizumab in patients with neovascular age-related macular degeneration. Br J Ophthalmol2013;97(3):266–271
17.
KodjikianLSouiedEHMimounGet al.GEFAL Study Group.Ranibizumab versus Bevacizumab for Neovascular Age-related Macular Degeneration: Results from the GEFAL Noninferiority Randomized Trial. Ophthalmology2013;120(11):2300–2309
HanhartJChowersIEvaluation of the Response to Ranibizumab Therapy following Bevacizumab Treatment Failure in Eyes with Diabetic Macular Edema.Case Rep Ophthalmol2015; 6(1):44–50
20.
DhootDSPieramiciDJNasirMet al.Residual edema evaluation with ranibizumab 0.5 mg and 2.0 mg formulations for diabetic macular edema (REEF study).Eye (Lond)2015;29(4):534–41
21.
MoisseievEKatzGMoisseievJet al.Switching Treatment For Neovascular Age-Related Macular Degeneration From Bevacizumab To Ranibizumab: Who Is Likely to Benefit From The Switch?Retina2015;35(7):1323–30.21
22.
KrzystolikMGStrauberSFAielloLPet al.Diabetic Retinopathy Clinical Research Network.Reproducibility of macular thickness and volume using Zeiss optical coherence tomography in patients with diabetic macular edema. Ophthalmology2007;114(8):1520–1525
23.
HuttonDNewman-CaseyPATavagMZacksDSteinJSwitching to less expensive blindness drug could save medicare part B $18 billion over a ten-year period.Health Aff (Millwood)2014;33(6):931–939
