Comparative effectiveness research of anti-vascular endothelial growth factor drugs in diabetic macular edema

Abstract

SUMMARY The study analyzes the patient data from the Department of Ophthalmology in National Cheng Kung University Hospital from 2015 to 2017 Three anti–vascular endothelial growth factor (anti-VEGF) medications are Lucentis (ranibizumab) Eylea (aflibercept) and Avastin (bevacizumab) The purposes of the study are comparing the effect of three anti-VEGF medications in treating the patient with diabetic macular edema finding out the effect of drug half-life and the possible risk factors which can influence the effect of treatment The result showed that the effect of drug half-life may be little Aflibercept is better than ranibizumab in improving best corrected visual acuity (BCVA) logarithm minimal angle resolution (LogMAR) central macular thickness (CMT) and average macular thickness (AMT) There is no significant difference between bevacizumab and ranibizumab Patients with panretinal photocoagulation may have decline in BCVA and LogMAR and thicker AMT Patients with tractional macular edema have worse improvement in CMT INTRODUCTION In the Wisconsin Epidemiologic Study of Diabetic Retinopathy cohort after 20 years of diabetes mellitus nearly 99% of patients with type 1 and 60% with type 2 disease demonstrated some degree of diabetic retinopathy Nowadays the mainstream treatment for diabetic macular edema is intravitreal anti-VEGF However ranibizumab and aflibercept are really expensive There is another choice: bevacizumab which is off-label use but much cheaper than ranibizumab and aflibercept The three goals for this study are as follows: First compare the effect of three anti-VEGF medications in treating the patients with diabetic macular edema Second find out the effect of drug half-life Third find out the possible risk factors which can influence the effect of treatment MATERIALS AND METHODS The study analyzes the patient data from the Department of Ophthalmology in National Cheng Kung University Hospital from 2015 to 2017 Three anti-VEGF medications are ranibizumab aflibercept and bevacizumab The study compares the change of visual acuity and macular thickness in different anti-VEGF medications The study adopts mixed effect model and analyzes the data in two ways One is to find out the effect of drug half-life The dependent variable is the difference of data measured before and after the injection The other is to find out the effect of interaction between three medications and treatment duration time without drug half-life effect The dependent variable is the data measured after the injection RESULTS AND DISCUSSION In the model with drug half-life there is no significant difference in BCVA and LogMAR per injection In CMT ranibizumab decreases 101um (P=0 003) aflibercept decreases 102um (P=0 002)、bevacizumab decreases 79um (P=0 014) per injection In AMT ranibizumab decreases 42um (P=0 002) aflibercept decreases 42um (P=0 002)、bevacizumab decreases 39um (P=0 011) per injection In the model without drug half-life before the treatment start aflibercept is worse 0 114 in BCVA (P

Date of Award	2019
Original language	English
Supervisor	Jung-Der Wang (Supervisor)