Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. Diabetic macular oedema is a common complication of diabetes, in which damage to the blood vessels at the back of the eye leads to swelling. Lucentis, Eylea and Avastin are three antiangiogenic drugs that can be injected into the eye to treat these blood vessels and reduce the swelling; and drugs with longer lasting effects have recently become available, such as Vabysmo and Beovue. In June 2023, Katie Curran from Queen’s University Belfast in the UK and colleagues, updated their Cochrane review of these drugs and used a network meta-analysis to compare their effects. Here’s Katie to tell us more.

Katie: Antiangiogenic therapy using anti-vascular endothelial growth factor, or anti-VEGF, therapy, has become the standard treatment to try to improve vision in patients with diabetic macular oedema, which I’ll call DMO for short. These drugs are injected directly into the eye and several drugs are available, making it important to compare their relative effects.
For this latest version of our review, we found 23 studies that had tested anti-VEGF and lasers. Most trials did not follow the patients for more than one year, and only 8 provided data on two years follow-up.
We found that all the anti-VEGF medicines tested prevent visual loss and can improve vision in people with DMO. In the trials with long enough follow-up, we found no important differences in vision at two years between any drug and the reference drug, Lucentis, but Eylea and Beovue yielded better control of retinal swelling than other drugs. Also, Eylea, Beovue and Vabysmo might confer some benefit over Lucentis at one year, but these differences may not be important.
In regard to safety, there was no evidence that the drugs increase the risk of death or cardiovascular events, but the quality of the evidence on these adverse effects was poor.
In summary, our updated review confirms that there is still limited evidence comparing the efficacy and safety of anti-VEGF drugs beyond one year of follow-up. We found no clinically important differences between the drugs in visual outcomes at two years in people with DMO, but there were differences in retinal thickness change. It’s also important to remember that evidence from trials may be difficult to apply in routine practice, where people in need of antiangiogenic treatment are often under-treated, and the individuals exposed to these drugs may be less healthy than those who took part in the trials.

Mike: If you would like to read more about the trials in Katie’s review and the findings of their network meta-analysis, you can see the full version online by going to Cochrane library dot com and searching for 'diabetic macular oedema and network meta-analysis'.