Aflibercept performed slightly better than ranibizumab for treating eyes with CRVO in this study. Photo: Joseph W. Sowka, OD, and Alan G. Kabat, OD. Click image to enlarge.

Anti-VEGF inhibitors are a leading treatment option for patients with central retinal vein occlusion (CRVO) and secondary macular edema; however, there are limited studies on patients treated routinely in clinical practice comparing the outcomes and effects of two of the most common anti-VEGF drugs, aflibercept and ranibizumab. Researchers of a recent study examined the 12-month outcomes of eyes with CRVO and found that those treated with aflibercept over ranibizumab may have a slight advantage.

Participants were gathered from centers included in the registry for the Fight Retinal Blindness! Project. The analysis involved 296 treatment-naive eyes of 291 patients who received either aflibercept (171 eyes, 2mg) or ranibizumab (125 eyes, 0.5mg) to treat macular edema brought on by CRVO. The main outcomes measured were the mean change in visual acuity (VA) at 12 months between anti-VEGF agents, mean change in central subfield thickness (CST), number of visits and number of injections.

The analysis revealed a significant 12-month adjusted mean VA change in aflibercept-treated patients compared with ranibizumab-treated patients (+16.6 letters vs. +9.8 letters). Mean crude VA improvement was also higher for aflibercept than for ranibizumab, even in eyes that switched or dropped out (+13.1 letters vs. +9.9 letters). As for CST, the mean adjusted change was much greater in aflibercept- vs. ranibizumab-treated eyes (304µm vs. 252µm). The number of visits and injections were comparable between the two groups.

“Significant differences in the molecular structure and mode of action of the drugs we studied may be the reason for the better outcomes we found with aflibercept for CRVO,” the researchers explained. “While ranibizumab is a humanized monoclonal antibody, aflibercept acts as a decoy receptor for VEGF and may offer superior VEGF suppression due to higher binding affinity against VEGF as well as longer intravitreal half-life. This may be particularly important in eyes with CRVO, which have very high vitreous levels of VEGF.”

In conclusion, both anti-VEGF drugs effectively improve VA and reduce CST in eyes with CRVO over one year of treatment, with aflibercept performing slightly better in terms of clinical outcomes.

Niedzwiecki M, Hunt A, Nguyen V, et al. 12-month outcomes of ranibizumab versus aflibercept for macular oedema in central retinal vein occlusion: data from the FRB! Registry. Acta Ophthalmol. September 13, 2021. [Epub ahead of print].