A two-year study finds that Eylea (aflibercept) outperforms Avastin (bevacizumab) in treating diabetic macular edema patients with moderate or worse vision loss.
Investigators at the Diabetic Retinopathy Clinical Research Network (DRCR.net) studied 660 people with diabetic macular edema at 89 clinical trial sites across the US. Diabetic macular edema occurs when fluid leaks from abnormal blood vessels into the retina, causing blurring of central vision.
The participants had an average age of 61 years at the beginning of the study, and an average duration of 17 years with either type 1 diabetes or type 2 diabetes.
Only participants with a visual acuity of 20/32 or worse were eligible to participate. This means that a person with 20/32 vision would have to be 20 feet away from an object that someone with normal vision could see clearly at 32 feet. Around half of participants had 20/32 to 20/40 vision, while the other half had 20/50 or worse vision.
Participants randomly received either Eylea (2.0 mg), Avastin (1.25 mg), or Lucentis (ranibizumab, 0.3 mg). Most received monthly injections for the first six months, and were then evaluated monthly during the first year and every 4-16 weeks during the second year. The number of injections participants received was roughly the same in each treatment group.
Among participants with 20/50 or worse vision, Eylea outperformed Avastin at the one- and two-year time points. Eylea outperformed Avastin at the one-year time point, but there were no statistical differences after two years. All three drugs improved the vision of 20/40 participants to a similar degree to an average of 20/25.
Lead author John A. Wells, M.D., Palmetto Retina Centre, Columbia, South Carolina, said: “The study suggests there is little advantage of choosing Eylea or Lucentis over Avastin when a patient’s loss of visual acuity from macular edema is mild, meaning a visual acuity of 20/40 or better.
“However, patients with 20/50 or worse vision loss may benefit from Eylea, which over the course of the two-year study outperformed Lucentis and Avastin.
“The results of the DRCR Network’s comparison of Eylea, Avasti, and Lucentis will help doctors and their patients with diabetic macular edema choose the most appropriate therapy.”
The study appears in Ophthalmology, the journal of the American Academy of Ophthalmology.

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