Treatment More Effective Than Laser Photocoagulation for Improving Diabetic Macular Edema

Aflibercept is safe and effective for improving visual and anatomical outcomes in patients with diabetic macular edema (DME), according to findings from a systematic review and meta-analysis published in the Journal of Current Ophthalmology.

“Aflibercept shows greater improvements when compared to laser photocoagulation overall,” wrote researchers. “Individual studies have shown an advantage of aflibercept when compared to bevacizumab anatomically, ranibizumab functionally at 1 year, and dexamethasone functionally.”

The systematic review included 30 investigations representing a variety study types, including randomized controlled trials and retrospective studies with heterogenous samples of patients with DME in real-life clinical settings. All participants had DME and received aflibercept for a minimum of 52 ± 4 weeks.

At 12 and 24 months, aflibercept was more effective than laser photocoagulation functionally, as measured by changes in best-corrected visual acuity (BCVA), as well as anatomically, as measured by central macular thickness, according to the meta-analysis.

Compared with bevacizumab, aflibercept was noninferior for improving BCVA at 12 and 24 months. In one study, aflibercept was more effective than bevacizumab anatomically at 1 and 2 years, reported researchers.

Compared with ranibizumab, aflibercept led to greater BCVA improvement at 1 year but not at 2 years. Central macular thickness did not differ significantly between ranibizumab and aflibercept at 12 or 24 months.

Meanwhile, compared with dexamethasone, aflibercept showed greater functional improvement but was inferior in reducing central macular thickness in one study.

“Aflibercept demonstrates a considerable safety profile in patients with DME,” added researchers. “Future research should assess the predictors of response to aflibercept. Furthermore, given the substantial differences in the cost associated with each treatment modality, cost-effectiveness studies taking into consideration the findings of the present study are warranted.”

Reference: 
Santhakumaran S, Salimi A, Brunetti VC, Galic J. Efficacy and safety of aflibercept therapy for diabetic macular edema: a systematic review and meta-analysis. J Curr Ophthalmol. 2022;34(2):133-147. doi:10.4103/joco.joco_308_21