DRCR.net Protocol T: At 2 years, Eylea, Avastin, Lucentis all reduce need for injections, improve visual acuity
Two-year results of the Diabetic Retinopathy Clinical Research Network Protocol T study show that about half the number of anti-VEGF injections needed to treat diabetic macular edema in the first year of the study were needed in the second year, regardless of which study agent was used.
The randomized clinical trial included 660 patients with visual acuity impairment from DME. Patients were randomized to receive intravitreal injections of 2 mg of Eylea (aflibercept, Regeneron), 1.25 mg of compounded Avastin (bevacizumab, Genentech) or 0.3 mg of Lucentis (ranibizumab, Genentech). Visual acuity improved in all three groups over the 2 years.
“This DRCR.net comparative effectiveness study for center-involved DME showed vision gains in all three drugs at the 2-year visit, with an average of almost half of the number of injections, slightly decreased frequency of visits and decreased amounts of focal/grid laser photocoagulation treatment in all three groups in the second year,” the study authors said.
Follow-up occurred every 4 weeks in the first year and every 4 weeks to 16 weeks in the second year, depending on the treatment course. Focal/grid laser photocoagulation was administered after 6 months if DME persisted.
At the 2-year follow-up, mean visual acuity improved by 12.8 letters in the aflibercept group, 10 letters in the bevacizumab group and 12.3 letters in the ranibizumab group.
In patients with baseline visual acuity of 20/50 or worse, mean visual acuity improved by 18.1 letters in the aflibercept group, 13.3 letters in the bevacizumab group and 16.1 letters in the ranibizumab group.
In patients with baseline visual acuity of 20/32 to 20/40, mean visual acuity improved by 7.8 letters in the aflibercept group, 6.8 letters in the bevacizumab group and 8.6 letters in the ranibizumab group.
Focal/grid laser coagulation was administered in 41% of patients in the aflibercept group, 64% of patients in the bevacizumab group and 52% of patients in the ranibizumab group. – by Nhu Te
Disclosure: Wells reports he receives grants from Allergan, Ampio, KalVista, Emmes, Neurotech, Lpath, National Institutes of Health and Ophthotech; grants and non-financial support from Genentech and Regeneron, during the conduct of the study; grants, personal fees and non-financial support from Iconic; and grants and personal fees from PanOptica, outside the submitted work. Please see the full study for all other authors’ relevant financial disclosures.
Editor's note: Mean visual acuity was corrected from 18.3 letters to 18.1 letters in the aflibercept group due to a typographical error in the DRCR.net manuscript published in Ophthalmology.