Aflibercept Versus Brolucizumab in Diabetic Macular Edema - A 2026 Clinical Review
Nikhil Prasad Fact checked by:Thailand Medical News Team Feb 26, 2026 1 hour, 54 minutes ago
Medical News: A major new scientific review has carefully examined two leading injectable treatments for diabetic macular edema, a serious eye complication of diabetes that can result in permanent vision loss. The study compares aflibercept and brolucizumab, two anti-VEGF medications that reduce retinal swelling and help protect sight.
A comprehensive 2026 review compares two leading injectable therapies for diabetic macular edema, highlighting
differences in durability and safety.
The research was conducted by experts from the “Carol Davila” University of Medicine and Pharmacy Bucharest, the Emergency University Hospital Bucharest, the “Vasile Goldis” Western University of Arad, and the “Lucian Blaga” University of Sibiu in Romania. Their comprehensive analysis offers valuable insights for ophthalmologists and patients managing diabetic retinal disease.
Understanding Diabetic Macular Edema
Diabetic macular edema, commonly referred to as DME, develops when prolonged high blood sugar damages the tiny blood vessels in the retina. These weakened vessels begin to leak fluid into the macula, the central region of the retina responsible for detailed vision. As fluid accumulates, the retina thickens, leading to blurred or distorted sight.
A protein called vascular endothelial growth factor, or VEGF, plays a central role in this process. VEGF increases blood vessel leakage and abnormal growth. Anti-VEGF medications are designed to block this protein, thereby reducing swelling and stabilizing vision.
How Aflibercept and Brolucizumab Differ
Aflibercept is a fusion protein that blocks multiple growth factors, including VEGF-A, VEGF-B, and placental growth factor. It has been widely used for many years and is supported by extensive long-term safety and efficacy data.
Brolucizumab, in contrast, is a smaller antibody fragment. Its compact structure allows a higher molar dose to be delivered into the eye, which may lead to stronger and longer-lasting VEGF suppression. This molecular design has raised interest in its potential to extend injection intervals and reduce treatment burden.
This
Medical News report emphasizes that although both drugs target VEGF, their structural differences influence their durability and safety profiles.
Evidence from Major Clinical Trials
Landmark trials such as VIVID and VISTA demonstrated that aflibercept significantly improved best-corrected visual acuity and reduced retinal thickness in patients with center-involving DME. These improvements were sustained over long-term follow-up periods of up to three years.
Meanwhile, the KESTREL and KITE trials showed that brolucizumab achieved vision gains that were non-inferior to aflibercept. In several analyses, brolucizumab produced numerically greater reductions in central retinal thickness. A considerable proportion of patients maintained disease cont
rol on 12-week dosing intervals after the initial treatment phase, suggesting a potential reduction in injection frequency.
Real-world observational studies further confirmed that both medications can improve or stabilize vision. In patients who switched to brolucizumab due to persistent swelling despite other treatments, significant anatomical improvements were observed in some cases.
Safety Profiles Require Careful Consideration
Aflibercept has demonstrated a well-established and predictable safety profile over years of use. Reported side effects are generally mild and consistent with intravitreal injection procedures.
Brolucizumab, however, has been associated with a higher incidence of intraocular inflammation, including retinal vasculitis and, rarely, retinal vascular occlusion. Although these events are uncommon, they can be serious and require prompt treatment. The review notes that inflammatory events appear less frequent in diabetic macular edema than in some other retinal diseases, yet careful monitoring remains essential.
Treatment Burden and Long-Term Management
DME is a chronic disease requiring repeated injections and ongoing monitoring. Frequent clinic visits can create logistical and financial challenges. Brolucizumab’s potential for longer dosing intervals may benefit selected patients who struggle with frequent appointments. However, safety considerations must be weighed against convenience.
Both drugs are high-cost biologic therapies, and long-term affordability and access remain important considerations in many healthcare systems.
Final Conclusions
The review concludes that both aflibercept and brolucizumab are effective and valuable options for treating diabetic macular edema. Aflibercept continues to serve as a reliable first-line therapy due to its strong evidence base and established safety record. Brolucizumab offers promising durability and potent anatomical effects, but its use requires careful patient selection and vigilant follow-up due to inflammatory risks. Ultimately, individualized treatment strategies that consider disease severity, prior response, patient lifestyle, and risk tolerance are essential for achieving optimal long-term visual outcomes in patients with diabetic retinal disease.
The study findings were published in the peer reviewed journal: Biomedicines.
https://www.mdpi.com/2227-9059/14/3/501
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Read Also:
https://www.thailandmedical.news/articles/ophthalmology-(eye-diseases)
https://www.thailandmedical.news/articles/diabetes
https://www.thailandmedical.news/articles/med-news
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