Real-world Treatment Outcomes using Vascular Endothelial Growth Factor Inhibitors for Retinal Vein Occlusion

Abstract

Purpose: Describe and compare real-world outcomes using ranibizumab, aflibercept or bevacizumab for macular oedema due to branch, central or hemi-retinal vein occlusion (RVO).

Design: Retrospective, multicentre, international, observational study using data from the prospectively designed Fight Retinal Blindness! registry.

Methods: Longitudinal mixed effects models predicted adjusted visual acuity (VA) and central subfield thickness (CST) through 12 and 36 months.

Main outcomes measures: Mean change in VA (primary) and CST, injections, visits, completion, switching, suspensions of therapy and adverse events.

Results: Six analyses included a total of 2,918 treatment-naïve eyes that commenced VEGF inhibitors for RVO in routine care. Mean changes in VA were largest using aflibercept for CRVO or HRVO, overall ranging from +8 to +16 letters at 12 months after 7-8 injections, maintained at +10 letters with around 17 injections through 36 months. Aflibercept reduced CST sooner and by a greater amount than ranibizumab and bevacizumab in BRVO and CRVO. Non-completers had similar outcomes in BRVO but worse outcomes in CRVO than completers. Switching between different VEGF inhibitors was most frequently to aflibercept with similar outcomes but more injections. Eyes switched from a VEGF inhibitor to a steroid tended to have had no change or to have lost some VA compared with baseline. It could be inferred that around half of all eyes suspended treatment within 36 months of starting it. Adverse outcomes were in keeping with previous reports.

Conclusions: Real-world outcomes in RVO using VEGF inhibitors were good at 12 months considering fewer injections were given than in clinical trials and maintained through 36 months. Eyes with HRVO had the greatest 12-month gains in VA of all RVO types. We found aflibercept to be the most efficacious agent, followed by ranibizumab then bevacizumab, particularly in CRVO. Half of eyes with BRVO or CRVO still required injections at 36 months.