[Ranibizumab and aflibercept for diabetic macular edema-retrospective study with real-life data after 12 months]

BACKGROUND

Currently only few data are available on a direct comparison of the treatment reality with ranibizumab and aflibercept in patients with diabetic macular edema (DME). This study assessed best corrected visual acuity (BCVA) outcomes and central retinal thickness (CRT) under treatment with ranibizumab and aflibercept.

MATERIAL AND METHODS

Patients with DME involving the fovea in treatment-naïve eyes and a follow-up period of least 12 months were retrospectively identified. Patients underwent treatment with ranibizumab 0.5 mg or aflibercept 2.0 mg. The findings were obtained using clinical examination, fluorescein angiography and spectral domain optical coherence tomography (SD-OCT, measuring CRT).

RESULTS

A total of 41 treatment-naïve eyes were identified in 29 patients with DME involving the fovea. The mean 12-month improvement was +9.5 letters in 19 eyes treated with ranibizumab and BCVA improving from 0.57 log MAR (95% confidence interval, CI 0.45-0.70 log MAR) to 0.38 log MAR (95% CI 0.25-0.50 log MAR; p < 0.001) and +8.5 letters in the aflibercept group with 22 eyes and BCVA improving from 0.38 log MAR (95% CI 0.25-0.51 log MAR) to 0.21 log MAR (95% CI 0.08-0.34 log MAR; p < 0.001). The difference between the two groups was not statistically significant (p = 0.599). When the initial visual acuity was 0.4 or less, the mean BCVA improved in 14 eyes treated with ranibizumab from 0.62 log MAR (95% CI 0.47-0.79 log MAR) to 0.38 log MAR (95% CI 0.21-0.55 log MAR), an improvement of 12.0 letters (p < 0.001), in 11 eyes treated with aflibercept from 0.63 log MAR (95% CI 0.42-0.84 log MAR) to 0.29 log MAR (95% CI 0.08-0.50 log MAR), an improvement of 17.0 letters (p < 0.001). The difference between the two groups was significant (p < 0.001). The mean number of intravitreal injections was 6.4 (95% CI 5.1-7.7) in the ranibizumab group, 7.5 (95% CI 6.2-8.8) in the aflibercept group (p = 0.199). The mean CRT decreased significantly (p < 0.001) in patients treated with both ranibizumab and aflibercept without any evidence of a significant difference between the two groups (p = 0.514).

DISCUSSION

In the patients studied ranibizumab and aflibercept showed a good safety and efficacy in the treatment of DME regarding BCVA and CRT under real-life conditions after 12 months. In cases of lower initial visual acuity (0.4 or 20/50 or less) aflibercept was more effective at improving vision.

[Hepatitis B and C infection in late repatriates]

105 late repatriates returning to Germany mostly from Russia, Ukraine and Kazakhstan were tested for present or past viral hepatitis B and 97 of them also for hepatitis C. Anti-HBc was found in 20% (95%-CI: 12,3-31,6%) and Anti-HCV in 3% (95%-CI: 1,3-8,0%) of tested individuals. 5% of tested persons were positive by PCR for HBV-DNA or HCV-DNA and therefore probably source of infection forthese viruses. All PCR positive individuals were not aware of their infection. Prevalence of hepatitis B and C infection was significantly higher than in the general population of Germany. Testing for viral hepatitis Band C should be offered to all late repatriates returning from areas with elevated prevalence of parenterally transmitted viral hepatitis. Further monitoring of the prevalence of viral hepatitis should be done in this group.