Interchangeability of bevacizumab, ranibizumab, and aflibercept questioned in new real-world study

Despite numerous head-to-head studies indicating statistical non-inferiority between bevacizumab, ranibizumab, and aflibercept in the treatment of neovascular age-related macular degeneration (nAMD), data from a new real-world study suggests that that there is loss of visual acuity and an increase in retinal edema after switching to bevacizumab, the drug which is often preferred because it is the less expensive option.

Patients with diagnosed nAMD who switched from aflibercept or ranibizumab to bevacizumab included in the clinical Berlin Macular Registry database were included in this study.

While being treated with aflibercept or ranibizumab (n = 63), there was a mean visual acuity decrease from 0.57 ± 0.05 to 0.68 ± 0.06 logMAR after switching to bevacizumab (P = 0.001). In addition, there was an increase in central retinal thickness from 308 µm ± 11 µm to 336 µm ± 16 µm (P = 0.011).

In the patients that were switched back to their initial drug, visual acuity increased from 0.69 ± 0.08 logMAR to 0.58 ± 0.09 logMAR (n = 26) and central retinal thickness decreased from 396 µm ± 28 µm to 337 µm ± 20 µm (N = 28).

“The data provides real-world evidence that there is loss of visual acuity and an increase in retinal edema after switching to bevacizumab. Thus, the assumption of free interchangeability cannot be confirmed in this cohort,” the authors concluded.

Reference
Riemer T, Berndt D, Böker A, et al. Treatment of neovascular age-related macular degeneration: insights into drug-switch real-world from the Berlin Macular Registry. Graefes Arch Clin Exp Ophthalmol. 2023;doi: 10.1007/s00417-022-05952-8. Epub ahead of print. PMID: 36633668.