"A twoyear clinical trial that compared three drugs for diabetic macular edema DME found that gains in vision were greater for participants receiving the drug Eylea aflibercept than for those receiving Avastin bevacizumab but only among participants starting treatment with  or worse vision.  Gains after two years were about the same for Eylea and Lucentis ranibizumab contrary to yearone results  httpsnei.nih.govnewspressreleasediabetic_macular_edemafrom the study which showed Eylea with a clear advantage. The three drugs yielded similar gains in vision for patients with  or  vision at the start of treatment. The clinical trial was conducted by the Diabetic Retinopathy Clinical Research Network DRCR.net which is funded by the National Eye Institute part of the National Institutes of Health. This rigorous trial confirms that Eylea Avastin and Lucentis are all effective treatments for diabetic macular edema said NEI Director Paul A. Sieving M.D. Ph.D. Eye care providers and patients can have confidence in all three drugs. Eylea Avastin and Lucentis are all widely used to treat DME a consequence of diabetes that can cause blurring of central vision due to the leakage of fluid from abnormal blood vessels in the retina. The macula is the area of the retina used when looking straight ahead. The drugs are injected into the eye and work by inhibiting vascular endothelial growth factor VEGF a substance that can promote abnormal blood vessel growth and leakage. Although the drugs have a similar mode of action they differ significantly in cost. Based on Medicare allowable charges the perinjection costs of each drug at the doses used in this study were about  for Eylea about  for Avastin and about  for Lucentis. DRCR.net investigators enrolled  people with DME at  clinical trial sites across the United States. When the study began participants on average were  years old with  years of type  or type  diabetes. Only people with a visual acuity of  or worse were eligible to participate to see clearly a person with  vision would have to be  feet away from an object that a person with normal vision could see clearly at  feet. At enrollment about half the participants had  to  vision. The other half had  or worse vision. In many states a corrected visual acuity of  or better in at least one eye is required for a drivers license that allows both day and nighttime driving. Each participant was assigned randomly to receive Eylea . milligrams. milliliter Avastin . mg. mL or Lucentis . mg. mL. Participants were evaluated monthly during the first year and every  weeks during the second year. Most participants received monthly injections during the first six months. Thereafter participants received additional injections of assigned study drug until DME resolved or stabilized with no further vision improvement.  Subsequently injections were resumed if DME worsened. Additionally laser treatment was given if DME persisted without continual improvement after six months of injections. Laser treatment alone was the standard treatment for DME until widespread adoption of antiVEGF drugs a few years ago. Among participants with  or better vision at the trials start all three drugs improved vision similarly on an eye chart. On average participants vision improved from  vision to . Among participants with  or worse vision at the trials start visual acuity on average improved substantially in all three groups. At two years Eylea participants were able to read about . additional lines on an eye chart Lucentis participants were able to read about three additional lines and Avastin participants improved about . lines compared with visual acuity before treatment. Eylea outperformed Avastin at the one and twoyear time points. While Eylea outperformed Lucentis at the oneyear time point by the twoyear time point gains in visual acuity were statistically no different. At the end of the trial average visual acuity was  to  among participants in all three groups. The results of the DRCR Networks comparison of Eylea Avastin and Lucentis will help doctors and their patients with diabetic macular edema choose the most appropriate therapy said John A. Wells M.D. the lead author of the study and a retinal specialist at the Palmetto Retina Center Columbia South Carolina. The study suggests there is little advantage of choosing Eylea or Lucentis over Avastin when a patients loss of visual acuity from macular edema is mild meaning a visual acuity of  or better. However patients with  or worse vision loss may benefit from Eylea which over the course of the twoyear study outperformed Lucentis and Avastin. The number of injections participants needed was about the same for all three treatment groups. Eylea Avastin and Lucentis participants on average required nine injections in the first year of the study and five in the second year. The need for laser treatment varied among the three treatment groups. By two years  percent of participants in the Eylea group received laser treatment to treat their macular edema compared with  percent of participants in the Avastin group and  percent in the Lucentis group. The risk of heart attack stroke or death from a cardiovascular condition or an unknown cause by end of the trial was higher among participants in the Lucentis group. Twelve percent of Lucentis participants had at least one event compared with five percent of participants in the Eylea group and eight percent of participants in the Avastin group. This difference in cardiovascular rates has not been seen across all other studies and therefore may be due to chance. Continued assessment of these serious cardiovascular events and their association with these drugs is important in future studies. Cardiovascular events such as heart attack and stroke are common complications of diabetes. The occurrence of eye complications such as eye infections and inflammation was similar for all three drugs. Results of the study were published online today in Ophthalmology the journal of the American Academy of Ophthalmology. Eylea and Lucentis were provided by drug manufacturers Regeneron and Genentech respectively. Additional research funding for this study was provided by the National Institute of Diabetes and Digestive and Kidney Diseases also a part of NIH. This important study would not have happened without funding from the National Institutes of Health and the cooperation of two competing companies said Adam R. Glassman M.S. principal investigator of the DRCR.Net Coordinating Center at the Jaeb Center for Health Research. The DRCR.net is dedicated to facilitating multicenter clinical research of diabetic eye disease. The Network formed in  and comprises more than  physicians practicing at more than  clinical sites across the country. For more information visit the DRCR.net website at httpdrcrnet.jaeb.org link is external httpdrcrnet.jaeb.org. The study was funded by grants EY EY and EY. The study is registered as NCT at ClinicalTrials.gov https   Macular edema can arise during any stage of diabetic retinopathy and is the most common cause of diabetesrelated vision loss. About . million Americans have diabetic retinopathy. Of these about  have DME. The NEI provides information about diabetic eye disease at http View an NEI video about how diabetic retinopathy can be detected through a comprehensive dilated eye exam at httpyoutu.besQRkPuo. NEI leads the federal governments research on the visual system and eye diseases. NEI supports basic and clinical science programs that result in the development of sightsaving treatments. For more information visit http The NIDDK a component of the NIH conducts and supports research on diabetes and other endocrine and metabolic diseases digestive diseases nutrition and obesity and kidney urologic and hematologic diseases. Spanning the full spectrum of medicine and afflicting people of all ages and ethnic groups these diseases encompass some of the most common severe and disabling conditions affecting Americans. For more information about the NIDDK and its programs visit http About the National Institutes of Health NIH NIH the nations medical research agency includes  Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic clinical and translational medical research and is investigating the causes treatments and cures for both common and rare diseases. For more information about NIH and its programs visit  https NIHTurning Discovery Into Health Reference Wells JA et al. for the Diabetic Retinopathy Clinical Research Network. Aflibercept Bevacizumab or Ranibizumab for Diabetic Macular Edema Twoyear Results from a Comparative Effectiveness Randomized Clinical Trial. Ophthalmology February  ."