Importance: The @entity6 Clinical Research Network (DRCR Network), sponsored by the National Eye Institute, reported the results of a comparative effectiveness @entity922 ( @entity922 ) evaluating the 3 anti-vascular endothelial growth factor (anti- @entity7 ) agents aflibercept (2.0 mg), bevacizumab (1.25 mg), and ranibizumab (0.3 mg) for treatment of @entity1103 ( @entity1103 ) involving the center of the retina and associated with visual acuity loss. The many important findings of the @entity922 prompted the American Society of Retina Specialists to convene a group of experts to provide their perspective regarding clinically relevant findings of the study. Objectives: To describe specific outcomes of the @entity922 judged worthy of highlighting, to discuss how these and other clinically relevant results should be considered by specialists treating @entity1103 , and to identify unanswered questions that merit consideration before treatment. Evidence Review: The DRCR Network-authored publication on primary outcomes of the comparative effectiveness @entity922 at 89 sites in the United States. The study period of the @entity922 was August 22, 2012, to August 28, 2013. Findings: On average, all 3 anti- @entity7 agents led to improved visual acuity in eyes with @entity227 , including mean (SD) improvements by +13.3 (11.1) letters with aflibercept vs +9.7 (10.1) letters with bevacizumab (P   <   .001) and +11.2 (9.4) letters with ranibizumab (P   =   .03). Worse visual acuity when initiating therapy was associated with greater visual acuity benefit of aflibercept (+18.9 [11.5]) over bevacizumab (+11.8 [12.0]) or ranibizumab (14.2 [10.6]) 1 year later (P   <   .001 for interaction with visual acuity as a continuous variable, and P   =   .002 for interaction with visual acuity as a categorical variable). It is unknown whether different visual acuity outcomes associated with the use of the 3 anti- @entity7 agents would be noted with other treatment regimens or with adequately repackaged bevacizumab, as well as in @entity1 with criteria that excluded them from the @entity922 , such as persistent @entity1103 despite recent anti- @entity7 treatment. Conclusions and Relevance: On average, all 3 anti- @entity7 agents led to improved visual acuity in eyes with @entity227 . Worse visual acuity when initiating therapy was associated with greater visual acuity benefit of aflibercept over bevacizumab or ranibizumab 1 year later. Care needs to be taken when attempting to extrapolate outcomes of this @entity922 to differing treatment regimens. With access to adequately repackaged bevacizumab, many specialists might initiate therapy with bevacizumab when visual acuity is good (ie, 20/32 to 20/40 as measured in the DRCR Network), recognizing that the cost-effectiveness of bevacizumab outweighs that of aflibercept or ranibizumab.

Comparison of Aflibercept, Bevacizumab, and Ranibizumab for Treatment of XXXX : Extrapolation of Data to Clinical Practice.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity227 :: ('MESH:D014786', 'Disease') :: ['DME involving the center of the retina and visual acuity impairment', 'DME involving the center of the retina and with visual acuity impairment'] @entity6 :: ('MESH:D003920', 'Disease') :: ['Diabetic Retinopathy'] @entity7 :: ('7422', 'Gene') :: ['VEGF'] @entity1103 :: ('MESH:D008269', 'Disease') :: ['DME', 'diabetic macular edema'] @entity922 :: ('MESH:D013568', 'Disease') :: ['RCT', 'randomized clinical trial']
@entity1103 :: (MESH:D008269,Disease) :: ['Diabetic Macular Edema']
