Despite being effective, anti-VEGF therapy has its shortcoming, said the presenters at a CME seminar at Hawaiian Eye and Retina 2021 which examined the current management of diabetic macular edema (DME).
The DRCR.net Protocol T study found that at 24 weeks, approximately 32% of patients treated with aflibercept (Eylea), 65% with bevacizumab (Avastin), and 41% with ranibizumab (Lucentis) had persistent DME, while results from the Phase 3 RISE and RIDE clinical trials found that persistent DME may lead to limited visual gains despite similar retinal thickness outcomes as a control group.
The presentation highlighted recent studies that analyzed visual outcomes in patients treated with anti-VEGF therapy for DME.
DRCR.net Protocol I Study
In this Phase 3, randomized, multicenter clinical trial ranibizumab in addition to laser was compared to steroid plus laser and sham plus laser for the treatment of patients with DME. After 3 injections, there was a limited visual response that was significantly associated with poor long-term visual outcomes with continued treatment. According to the presentation, “Within each of the initial BCVA response categories, the BCVA change from baseline at 52 weeks through 3 years did not vary by more than 5 ETDRS letters from the observed mean BCVA response at 12 weeks.”
Protocol I (Excess Edema) Post Hoc Analysis
This analysis aimed to examine the relationship between ocular anatomy and function in patients with DME and found that in the first 52 weeks after anti-VEGF treatment, excess edema is significantly associated with fewer letters gained at 3 years. Consistent control over macular edema over time may lead to better vision improvement.
Treatment Switch Outcomes in DME: IRIS Registry Database Analysis
In this retrospective analysis of data from patients with DME who switched between anti-VEGF agents in the first year, no significant improvement in mean visual acuity was observed. The mean time until switching agents was 8 months.
Fortun J. Diabetic Macular Edema Management in 2021: What’s New? Presented at: Hawaiian Eye and Retina 2021.
This presentation was supported by an educational grant from Allergen.