title: Individualized Stabilization Criteria-Driven Ranibizumab versus Laser in Branch Retinal Vein Occlusion: Six-Month Results of BRIGHTER.
abstract: To compare the 6-month efficacy and safety profile of an individualized stabilization criteria-driven pro re nata (PRN) regimen of ranibizumab 0.5 mg with or without laser versus laser alone in patients with visual impairment due to macular edema secondary to branch retinal vein occlusion (BRVO).
  
  
  
  A 24-month, prospective, open-label, randomized, active-controlled, multicenter, phase IIIb study.
  
  
  
  A total of 455 patients.
  
  
  
  Eligible patients were randomized 2:2:1 to receive ranibizumab (n = 183), ranibizumab with laser (n = 180), or laser only (n = 92). Patients treated with ranibizumab with or without laser received a minimum of 3 initial monthly ranibizumab injections until visual acuity (VA) stabilization, and VA-based PRN dosing thereafter. In the ranibizumab with laser and laser-only groups, laser was given at the investigator's discretion at a minimum interval of 4 months and if VA was <79 letters.
  
  
  
  Mean change from baseline at month 6 in best-corrected visual acuity (BCVA) (primary end point) and central subfield thickness, and safety over 6 months. Exploratory objectives were to evaluate the influence of baseline BCVA, disease duration, and ischemia on BCVA outcomes at month 6.
  
  
  
  Baseline mean BCVA was 57.7 letters, and mean BRVO duration was 9.9 months. Ranibizumab with or without laser was superior to laser only in improving mean BCVA from baseline at month 6 (14.8 and 14.8 vs. 6.0 letters; both P < 0.0001; primary end point met). Patients with a shorter BRVO duration at baseline had a higher mean BCVA gain than those with a longer BRVO duration. Patients with a poor baseline VA had a better BCVA gain than those with a higher baseline VA, although final BCVA was lower in those with poor baseline VA. In the ranibizumab with or without laser groups, the presence of some macular ischemia at baseline did not influence mean BCVA gains. There were no new ocular or nonocular safety events.
  
  
  
  Ranibizumab with an individualized VA-based regimen, with or without laser, showed statistically significant superior improvement in BCVA compared with laser alone in patients with BRVO. Overall, there were no new safety events other than those reported in previous studies.
authors.affiliation: Ophthalmology Department, Hôpital Lariboisière, AP-HP, Université Paris 7 - Sorbonne Paris Cité, Paris, France. Electronic address: ramin.tadayoni@aphp.fr.
authors.forename: Ramin
authors.initials: R
authors.lastname: Tadayoni
authors.affiliation: Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
authors.forename: Sebastian M
authors.initials: SM
authors.lastname: Waldstein
authors.affiliation: Clinica Oculistica, University of Sassari, Sassari, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Boscia
authors.affiliation: Department of Retinology, Klinik Pallas, Olten, Switzerland; Department of Ophthalmology, University of Münster, Münster, Germany.
authors.forename: Heinrich
authors.initials: H
authors.lastname: Gerding
authors.affiliation: St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom.
authors.forename: Ian
authors.initials: I
authors.lastname: Pearce
authors.affiliation: Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Priglinger
authors.affiliation: Novartis Pharma AG, Basel, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Wenzel
authors.affiliation: Novartis Pharma AG, Basel, Switzerland.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Barnes
authors.affiliation: Novartis Pharma AG, Basel, Switzerland.
authors.forename: Margarita
authors.initials: M
authors.lastname: Gekkieva
authors.affiliation: Munich Re, Munich, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Pilz
authors.affiliation: Institut de la Màcula, Centro Médico Teknon, and Barcelona Macula Foundation, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Monés
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D058449:Intravitreal Injections; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000069579:Ranibizumab / Q000009:adverse effects / Q000627:therapeutic use*; D012170:Retinal Vein Occlusion / Q000175:diagnosis / Q000188:drug therapy*; D019233:Retreatment; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab