Anti-VEGF treatment switch in real-world DME patients: ranibizumab versus aflibercept for bevacizumab DME non-responding patients (SWIRL study)
Background/aims To describe the functional outcomes of patients with diabetic macular oedema (DME) non-responsive to bevacizumab switched to ranibizumab or aflibercept over 1 year and the demographic and anatomic predictors of these functional outcomes.Methods In a retrospective real-world cohort st...
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BMJ Publishing Group
2025-08-01
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| Series: | BMJ Open Ophthalmology |
| Online Access: | https://bmjophth.bmj.com/content/10/1/e002178.full |
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| author | Yu Qiang Soh Zheng Xian Thng Wei Kiong Ngo Colin S Tan Tock Han Lim Louis W Lim Augustinus Laude Darren Choy Wen Jun Song Helen Fang Mi Koh Lilian Jacob Yu Hang Chin Karen Jhi Wen Chia Issac Too Nicola Y Gan Rajesh Rajagopalan |
| author_facet | Yu Qiang Soh Zheng Xian Thng Wei Kiong Ngo Colin S Tan Tock Han Lim Louis W Lim Augustinus Laude Darren Choy Wen Jun Song Helen Fang Mi Koh Lilian Jacob Yu Hang Chin Karen Jhi Wen Chia Issac Too Nicola Y Gan Rajesh Rajagopalan |
| author_sort | Yu Qiang Soh |
| collection | DOAJ |
| description | Background/aims To describe the functional outcomes of patients with diabetic macular oedema (DME) non-responsive to bevacizumab switched to ranibizumab or aflibercept over 1 year and the demographic and anatomic predictors of these functional outcomes.Methods In a retrospective real-world cohort study, 76 consecutive patients with DME non-responsive to bevacizumab were reviewed at baseline and 12 months after switch to ranibizumab or aflibercept. Visual acuity (VA) and optical coherence tomography features such as central retinal thickness were assessed. Multiple logistic regression was performed to determine predictors for outcomes.Results From baseline to 1 year, the overall best-corrected VA improved by LogMAR 0.015±0.19 with no difference between patients who switched to ranibizumab or aflibercept (LogMAR 0.017±0.21 vs LogMAR 0.013±0.17, p=0.92). Ranibizumab patients had more reduction in central subfield thickness (CST) (390.13 µm vs 334.20 µm, p=0.033) than aflibercept patients. Baseline HbA1c (p=0.012) and number of bevacizumab injections (p=0.040) were significantly associated with gain in VA, while change in CST was a strong predictor of VA change (p<0.01). Aflibercept patients were more likely to gain vision after 6 months but not at 12 months.Conclusions In a real-world study, improvements in functional outcomes can still be gained after switching anti-vascular endothelial growth factor in bevacizumab non-responders. Both ranibizumab and aflibercept were comparable and effective treatments. |
| format | Article |
| id | doaj-art-c1c6acf57b734416b287714b1e09ee8d |
| institution | Matheson Library |
| issn | 2397-3269 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Ophthalmology |
| spelling | doaj-art-c1c6acf57b734416b287714b1e09ee8d2025-08-02T02:55:10ZengBMJ Publishing GroupBMJ Open Ophthalmology2397-32692025-08-0110110.1136/bmjophth-2025-002178Anti-VEGF treatment switch in real-world DME patients: ranibizumab versus aflibercept for bevacizumab DME non-responding patients (SWIRL study)Yu Qiang Soh0Zheng Xian Thng1Wei Kiong Ngo2Colin S Tan3Tock Han Lim4Louis W Lim5Augustinus Laude6Darren Choy7Wen Jun Song8Helen Fang Mi9Koh Lilian10Jacob Yu Hang Chin11Karen Jhi Wen Chia12Issac Too13Nicola Y Gan14Rajesh Rajagopalan15National Healthcare Group Eye Institute, SingaporeNational Healthcare Group Eye Institute, SingaporeNational Healthcare Group Eye Institute, SingaporeNational Healthcare Group Eye Institute, SingaporeNational Healthcare Group Eye Institute, SingaporeOphthalmology, Woodlands Health, SingaporeNational Healthcare Group Eye Institute, SingaporeNational Healthcare Group Eye Institute, SingaporeNational Healthcare Group Eye Institute, SingaporeNational Healthcare Group Eye Institute, SingaporeOphthalmology, Woodlands Health, SingaporeNational Healthcare Group Eye Institute, SingaporeNational Healthcare Group Eye Institute, SingaporeNovartis AG, SingaporeNational Healthcare Group Eye Institute, SingaporeNational Healthcare Group Eye Institute, SingaporeBackground/aims To describe the functional outcomes of patients with diabetic macular oedema (DME) non-responsive to bevacizumab switched to ranibizumab or aflibercept over 1 year and the demographic and anatomic predictors of these functional outcomes.Methods In a retrospective real-world cohort study, 76 consecutive patients with DME non-responsive to bevacizumab were reviewed at baseline and 12 months after switch to ranibizumab or aflibercept. Visual acuity (VA) and optical coherence tomography features such as central retinal thickness were assessed. Multiple logistic regression was performed to determine predictors for outcomes.Results From baseline to 1 year, the overall best-corrected VA improved by LogMAR 0.015±0.19 with no difference between patients who switched to ranibizumab or aflibercept (LogMAR 0.017±0.21 vs LogMAR 0.013±0.17, p=0.92). Ranibizumab patients had more reduction in central subfield thickness (CST) (390.13 µm vs 334.20 µm, p=0.033) than aflibercept patients. Baseline HbA1c (p=0.012) and number of bevacizumab injections (p=0.040) were significantly associated with gain in VA, while change in CST was a strong predictor of VA change (p<0.01). Aflibercept patients were more likely to gain vision after 6 months but not at 12 months.Conclusions In a real-world study, improvements in functional outcomes can still be gained after switching anti-vascular endothelial growth factor in bevacizumab non-responders. Both ranibizumab and aflibercept were comparable and effective treatments.https://bmjophth.bmj.com/content/10/1/e002178.full |
| spellingShingle | Yu Qiang Soh Zheng Xian Thng Wei Kiong Ngo Colin S Tan Tock Han Lim Louis W Lim Augustinus Laude Darren Choy Wen Jun Song Helen Fang Mi Koh Lilian Jacob Yu Hang Chin Karen Jhi Wen Chia Issac Too Nicola Y Gan Rajesh Rajagopalan Anti-VEGF treatment switch in real-world DME patients: ranibizumab versus aflibercept for bevacizumab DME non-responding patients (SWIRL study) BMJ Open Ophthalmology |
| title | Anti-VEGF treatment switch in real-world DME patients: ranibizumab versus aflibercept for bevacizumab DME non-responding patients (SWIRL study) |
| title_full | Anti-VEGF treatment switch in real-world DME patients: ranibizumab versus aflibercept for bevacizumab DME non-responding patients (SWIRL study) |
| title_fullStr | Anti-VEGF treatment switch in real-world DME patients: ranibizumab versus aflibercept for bevacizumab DME non-responding patients (SWIRL study) |
| title_full_unstemmed | Anti-VEGF treatment switch in real-world DME patients: ranibizumab versus aflibercept for bevacizumab DME non-responding patients (SWIRL study) |
| title_short | Anti-VEGF treatment switch in real-world DME patients: ranibizumab versus aflibercept for bevacizumab DME non-responding patients (SWIRL study) |
| title_sort | anti vegf treatment switch in real world dme patients ranibizumab versus aflibercept for bevacizumab dme non responding patients swirl study |
| url | https://bmjophth.bmj.com/content/10/1/e002178.full |
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