First Author: J.Nassaralla BRAZIL
Co Author(s): L. Teixeira
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Several of the studies currently show an efficacy of ranibizumab through visual acuity acquired through ad 12-to-24-month follow-up, also showing visual loss after intravitreal application. Other studies have shown that aflibercept is one of the most effective anti-VEGFs with the most different properties and, sometimes, the visual acuity lost after ranibizumab does not exist in this drug. In view of the importance of these anti-VEGFs and the necessity for the new discovery of new therapies for DME, this clinical essay combines these two drugs and objectively shows the results in the retina with the follow up using optical coherence tomography.
To combine 2 drugs in diabetic macular edema treatment
A randomized clinical trial was performed in patients attended in Goiania Eye Institute, diagnosed with diabetic macular edema from October 2015 to January 2016, with the purpose of evaluating and comparing the efficacy of treatment with aflibercept and ranibizumab, According to the research protocol, group 01 received 03 intravitreal injections of 0,1 ml ranibizumab with a 30-day interval between the applications and follow-up with the optical coherence tomography on subsequent days 01, 03, 05, 10 and 30, with the evaluation of the macular thickness in each examination. The same was done with the other groups, and in group 02 the eyes received two doses of aflibercept (0,1 ml) with a dose of ranibizumab (0,1 ml) intercalated; in group 03, the eyes received 02 doses of ranibizumab (0,1 ml) interspersed with a dose of aflibercept (0,1 ml) with a 30-day interval, and in the fourth group, the patients received three doses of aflibercept with a 30-day interval.
Of the four groups randomly selected and submitted to alternating treatment with aflibercept, ranibizumb, or even aflibercept and ranibizumab, we observed in Graph 01 that group 02 (patients submitted to two applocations of aflibercept intercalated to a ranibizumab application) there was a reduction of diabetic macular edema of about 31,24% up to the thirtieth day after the third injection, that shown to be superior to other groups mentioned, but similar to the reduction observed observed with the only application of alibercept (group 04) in which it was observed a 27,42% reduction of the edema. In the other groups, a lower DME reduction was observed when only ranibizumab (group 01) was administrated, with a significant increase in edema reduction with the application of only one one interleaved dose of aflibercept (group 03).
We can state through this study that the treatment of diabetic macular edema with anto-VEGF association has a greater benefit than the treatment with only one of these drugs, shown by optical coherence tomography. Besides that, it can be shown that the tolerance effect is mainly present with ranibizumab, and that aflibercept has potentiated action when a dose of ranibizumab is intercalated, with increasing effect dose after dose until the third application.