Anti–Vascular Endothelial Growth Factor Comparative Effectiveness Trial for Diabetic Macular Edema

Authors:
  • FNfor the Diabetic Retinopathy Clinical Research Network
    for the Diabetic Retinopathy Clinical Research Network
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Abstract
The Diabetic Retinopathy Clinical Research Network (DRCR.net) Protocol T, which is a comparison of the anti–vascular endothelial growth factor (VEGF) agents aflibercept, bevacizumab, and ranibizumab for treatment of center-involving diabetic macular edema (DME) with vision loss,1-4 has prompted discussions at conferences and requests by peer-reviewed and non–peer-reviewed journals for post hoc analyses. At 1 and 2 years,1,4 the mean visual acuity (VA) improvement with all 3 agents was similar for eyes with VAs of 20/32 to 20/40 at randomization. For a baseline VA of 20/50 or worse, aflibercept produced a greater improvement in mean VA than the other agents at 1 year. Improvement in VA at the 2-year time point with aflibercept remained statistically superior to bevacizumab but not ranibizumab.4 Mean letter changes in VA from 1 to 2 years in each group were small (aflibercept: letter score change, −1.2; 95% CI, −3.2 to 0.8; P = .24; bevacizumab: letter score change, +0.3; 95% CI, −2.3 to 2.8; P = .85; and ranibizumab: letter score change, +1.1; 95% CI, −1.4 to 3.6; P = .40; P values testing whether within-group change differed from 0 [2-tailed t test]). Despite these small differences, some might interpret the 2-year results as revealing convergence in the subgroup with worse baseline VA. This article examines VA outcomes over time, explores the potential effect of focal/grid laser treatment on retinal thickness, and hypothesizes potential reasons for the decreasing number of injections over 2 years.

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