Table 1.

Anti-VEGF therapies in diabetic macular edema and diabetic retinopathy.

Drug	Mechanism of Action	Dose	Gain in Letters in DME	Change in DR	Studies
Pegaptanib	Pegylated oligoribonucleotide (aptamer), binds to VEGF165	0.3 mg q6	1 year: +5.2 2 year: +6.1	Reduction of NV in eight out of 19 patients	[18,19]
Bevacizumab	Humanized murine full-length mAb, binds VEGF-A alone	1.25 mg	1 year (20/32–20/40): +7.5 1 year (20/50–20/320): +11.8 2 year (20/32–20/40): +6.8 2 year (20/50–20/320): +13.3	2 years: 30% improvement *	[20]
Ranibizumab	Humanized murine mAb fragment, binds VEGF-A, higher affinity	0.3 mg 0.5 mg	1 year (20/32–20/40): +8.3 1 year (20/50–20/320): +14.2 2 year (20/32–20/40): +8.6 2 year (20/50–20/320): +16.1	2 years: 38% improvement * Less visual field lost at 5 years vs PRP	[14,20]
Aflibercept	Human fusion protein of the IgG Fc region, binds VEGF-A, VEGF-B, PlGF-1 and PlGF-2	2.0 mg q8	1 year (20/32–20/40): +8.0 1 year (20/50–20/320): +18.9 2 year (20/32–20/40): +7.8 2 year (20/50–20/320): +18.1	2 years: 70% improvement 2 years: 62% improvement 33% need of vitrectomy	[20,21,22,23]
Conbercept	Recombinant fusion protein, Binds VEGF-A, -B, and PlGF	0.5 mg	1 year: +8.6 Laser crossover	No RCT Improvement in NV severity	[24]
Brolucizumab	Single-chain antibody fragment (scFv) with high affinity for VEGF	6 mg q6-q12 dosing 50–55% •	1 year: +9.2 and +10.6	29.6% improvement *	[25]
Faricimab	Bispecific antibody Inhibit Ang-2 and VEGF-A	6 mg >70% achieved q12 in T&E	YOSEMITE 1 year: +10.7 q8 +11.8 PTI RHINE 1 year: +11.8 q8 +10.8 PTI	YOSEMITE 1 year: 46% q8 42.5% PTI RHINE 1 year: 44.2% q8 43.7% PTI	[26]

NV: neovascularization; PTI: personalized treatment interval (YOSEMITE and RHINE); RCT: randomized controlled trial; * Improvement from baseline: ETDRS diabetic retinopathy severity scale level improved by at least two levels or there was complete regression of active proliferative diabetic retinopathy (PDR). • probability of q12 dosing posterior to loading phase through week 52.