Short-Term Outcomes of Switching Therapy from Bevacizumab Non-Responder to Ranibizumab in Diabetic Macular Edema
Wipada Laovirojjanakul¹, Watcharaporn Thongme¹, Navapol Kanchanaranya², Sritatath Vongkulsiri³, Pichai Jirarattanasopa⁴, Nawat Watanachai⁵, Tanapat Ratanapakorn¹, Chavakij Bhoomibunchoo¹, Thuss Sanguansak¹, Suthasinee Sinawat¹
Affiliation : ¹ KKU Eye Center, Department of Ophthalmology, Khon Kaen University, Khon Kaen, Thailand ² Thammasart Eye Center, Department of Ophthalmology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand ³ Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok Thailand ⁴ Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand ⁵ Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Objective: To evaluate the short-term efficacy of ranibizumab therapy in terms of visual function and retinal thickness in patients with diabetic macular edema (DME) who failed to respond to treatment with repeated bevacizumab injections. Additionally, parameters affecting outcomes after switching were investigated.
Materials and Methods: The present study was a multicenter, retrospective study of 70 eyes with DME non-responding to bevacizumab. All patients were initially treated with at least three consecutive injections of bevacizumab then switched to at least one injection of ranibizumab. A monthly follow-up after the first ranibizumab injection to the last injection within six months was monitored. Primary outcomes included mean change in best-corrected visual acuity (BCVA) and central subfield thickness (CSFT) changes from baseline. Exploratory outcomes included parameters affecting prognosis after switching.
Results: Seventy eyes with DME were included in the present study. The mean change of BCVA (logMAR) was 0.075±0.375 (95% CI 0.014 to 0.164, p=0.098). The mean change of CSFT was 58.85±110.37 μm (95% CI 32.54 to 85.17, p<0.001). Forty-two percent of patients had BCVA improvement and 75.71% had CSFT improvement after switching to ranibizumab. Factors associated with BCVA and CSFT improvement were baseline BCVA, baseline CSFT, and older than 50 years old.
Conclusion: Switching to ranibizumab therapy in DME patients unresponsive to repeated bevacizumab injection provides better anatomical outcomes than visual acuity improvement. This will help ophthalmologists better understand the benefits on switching therapy to ranibizumab in terms of visual function and retinal thickness in patients with DME in the real-world setting.
Received 13 December 2021 | Revised 9 February 2022 | Accepted 14 February 2022
DOI: 10.35755/jmedassocthai.2022.04.13285
Keywords : Diabetes, macular edema; Anti-vascular endothelial growth factor (VEGF); Intravitreal injection; Non-responder; Persistent diabetic
macular edema
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