medwireNews: Starting people on bevacizumab and switching to aflibercept only when necessary keeps costs down without compromising treatment efficacy for people with diabetic macular edema, shows a randomized trial.
As reported in The New England Journal of Medicine, 132 eyes were randomly assigned to receive, and completed, 2 years of treatment with the more expensive aflibercept, during which they achieved an average 15-letter improvement in visual acuity.
A further 128 eyes completed 2 years of treatment that started with the cheaper bevacizumab and switched to aflibercept if improvement stalled, which occurred for 70% of eyes. Visual acuity in this group improved by an average of 14 letters, which was not significantly different from the gains in the aflibercept monotherapy group. Changes in retinal central subfield thickness were also similar between the groups.
In a press statement, study author Adam Glassman (Jaeb Center for Health Research, Tampa, Florida, USA) stressed that participants did improve on bevacizumab, even if a switch to aflibercept was ultimately required.
“There are large cost disparities between these drugs, so differences in treatment strategies may have substantial cost implications,” he said.
In a linked editorial, David Musch (University of Michigan, Ann Arbor, USA) and Emily Chew (National Eye Institute, Bethesda, Maryland, USA) say that the trial overall “presents evidence that applies well to clinical practice.”
But they stress that participants who started on bevacizumab were monitored more frequently than is common in routine practice, where less frequent monitoring could leave open the risk for a delayed switch to aflibercept and irreversible vision loss.
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N Engl J Med 2022; doi:10.1056/NEJMoa2204225
N Engl J Med 2022; doi:10.1056/NEJMe2208454