Ranibizumab or Aflibercept for Diabetic Macular Edema: One-Year Comparison of Real-World Outcomes from Fight Retinal Blindness! Registry

International audiencePurpose : To compare the 12 months treatment outcomes of ranibizumab and aflibercept for diabetic macular edema (DME) in routine clinical practice.Methods : This was a retrospective analysis of data from a prospectively designed observational registry: the Fight Retinal Blindness! Project. Treatment-naïve eyes that started either ranibizumab (0.5mg) or aflibercept (2mg) for DME from 1 December 2013 to 1 June 2018 were identified. The primary outcome was the mean change in visual acuity (VA in logMAR letters) from baseline to 12 months.Results : We identified 383 eyes (Ranibizumab – 166, Aflibercept – 217) of 291 patients. Eyes of patients in the aflibercept group had a lower mean VA (mean difference [MD] -3.1 letters) and a thicker maculae (MD +26μm) than those of ranibizumab at baseline which was not significantly different (Table 1). Patients on ranibizumab were older (MD +2.7 years). The adjusted MD in VA change and central subfield thickness (CST) reduction were +1 letter (1.4 for aflibercept versus 0.4 for ranibizumab, p=0.4) and -30 microns (-85 versus -55, p<0.01) in eyes with initial VA ≥20/40 and +3 letters (10.6 versus 7.6, p<0.01) and -46 microns (-148 versus -102, p<0.02) in those presenting with VA ≤20/50. Eyes in the aflibercept group received more injections over 12 months, median (Q1, Q3) of 8 (6, 9), than the ranibizumab group, 6 (4, 8), though this difference was not significant (p=0.13). Treatment switches, albeit low, were more frequent from ranibizumab to aflibercept than vice versa. Significantly more eyes in the aflibercept group were lost to follow-up within 12 months (21% versus 9% ranibizumab, P