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Twelve-month outcomes of ranibizumab versus aflibercept for macular oedema in branch retinal vein occlusion: data from the FRB! registry
  1. Adrian R Hunt1,2,
  2. Vuong Nguyen3,
  3. Catherine P Creuzot-Garcher4,
  4. Socorro Alforja5,
  5. Pierre-Henry Gabrielle4,6,
  6. Javier Zarranz-Ventura5,
  7. Martin Guillemin4,
  8. Samantha Fraser-Bell3,
  9. Ricardo P Casaroli Marano5,
  10. Jennifer Arnold7,
  11. Ian L McAllister8,
  12. Louise O'Toole9,
  13. Mark C Gillies2,
  14. Daniel Barthelmes10,
  15. Hemal Mehta11,12
  1. 1 Medical Retina, Westmead Hospital, Westmead, New South Wales, Australia
  2. 2 Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
  3. 3 Clinical Ophthalmology & Eye Health, The University of Sydney, Sydney, New South Wales, Australia
  4. 4 Ophthalmology, Centre Hospitalier Universitaire de Dijon, Dijon, Bourgogne, France
  5. 5 Institut Clínic de Oftalmologia (ICOF), Hospital Clinic de Barcelona, Barcelona, Spain
  6. 6 Eye and Nutrition Research Group, Centre des Sciences du Goût et de l'Alimentation, INRA Centre de Dijon, Dijon, Bourgogne, France
  7. 7 Marsden Eys Specialists, Parramatta, Greater Western Sydney, Australia
  8. 8 Lions Eye Institute, The University of Western Australia, Nedlands, Western Australia, Australia
  9. 9 The Mater Private Hospital, Dublin, Leinster, Ireland
  10. 10 UniversitatsSpital Zurich Augenklinik und Poliklinik, Zurich, ZH, Switzerland
  11. 11 Medical Retina, Sydney Eye Hospital, Sydney, New South Wales, Australia
  12. 12 Medical Retina, Moorfields Eye Hospital, London, UK
  1. Correspondence to Dr Adrian R Hunt, Ophthalmology, Save Sight Institute, The University of Sydney, Sydney, NSW 2006, Australia; adrianhunt{at}


Background/Aims To compare the efficacy of ranibizumab (0.5 mg) with aflibercept (2 mg) in the treatment of cystoid macular oedema due to branch retinal vein occlusion (BRVO) over 12 months.

Methods A multicentre, international, database observational study recruited 322 eyes initiating therapy in real-world practice over 5 years. The main outcome measure was mean change in EDTRS letter scores of visual acuity (VA). Secondary outcomes included anatomic outcomes, percentage of eyes with VA >6/12 (70 letters), number of injections and visits, time to first inactivity, switching or non-completion.

Results Generalised mixed effect models demonstrated that mean (95% CI) adjusted 12-month VA changes for ranibizumab and aflibercept were similar (+10.8 (8.2 to 13.4) vs +10.9 (8.3 to 13.5) letters, respectively, p=0.59). The mean adjusted change in central subfield thickness (CST) was greater for aflibercept than ranibizumab (−170 (−153 to –187) µm vs −147 (−130 to –164) µm, respectively, p=0.001). The overall median (Q1, Q3) of 7 (4, 8) injections and 9 (7, 11) visits was similar between treatment groups. First grading of inactivity occurred sooner with aflibercept (p=0.01). Switching was more common from ranibizumab (37 eyes, 23%) than from aflibercept (17 eyes, 11%; p=0.002).

Conclusion Visual outcomes at 12 months in this direct comparison of ranibizumab and aflibercept for BRVO in real-world practice were generally good and similar for the 2 drugs, despite a greater effect of aflibercept on CST and time to first grading of inactivity.

  • macula
  • retina
  • treatment medical
  • vision

Data availability statement

Data are not publicly available. The statistical analysis plan can be obtained by request.

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Data availability statement

Data are not publicly available. The statistical analysis plan can be obtained by request.

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  • Contributors MG and DB are inventors of the software used to collect the data for this analysis, initiated the collaborative project and revised the paper. HM implemented the trial in the UK designed and revised the paper. VN monitored data collection for the whole trial. ARH implemented the trial in Australia and with VN drafted and revised the statistical analysis plan, cleaned and analysed the data and ARH drafted and revised the paper. ARH is guarantor. CPC-G and MG implemented the trial in France and revised the paper. P-HG and SF-B revised the paper. SA, RPCM and JZ-V implemented the trial in Spain and revised the paper. JA and ILMcA revised the paper. LO'T implemented the trial in Ireland and revised the paper.

  • Funding This work was supported by a grant from the Royal Australian NZ College of Ophthalmologists Eye Foundation (2007-2009) and a grant from the National Health and Medical Research Council, Australia (NHMRC 2010-1012).

  • Competing interests MCG and DB are inventors of the software used to collect the data for this analysis. JA, ILMcA and MCG are members of advisory boards for Novartis and Bayer. JA and MCG are also members of advisory boards for Allergan. MCG and JA report personal fees and others from Novartis, others from Bayer, outside the submitted work. DB received a research grant from Novartis.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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