Diabetic Macular Edema

Current and future pharmacotherapies are changing the treatment landscape of DME

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The most common pharmacotherapies for diabetic macular edema (DME) are safe and effective and the current focus is on developing more durable treatments, according to a presentation by Michael S. Ip, MD at Hawaiian Eye and Retina 2021.

“We’ve got a number of really good therapies,” said Dr Ip during this presentation. “Now were trying to fine-tune what we know and understand, and how we approach the problem of DME.”

The 3 most common anti-vascular endothelial growth factor (VEGF) therapies used in the treatment of DME include ranibizumab, aflibercept, and bevacizumab. Dr Ip said that data from the Diabetic Retinopathy Clinical Research Network’s Protocol T and Protocol V studies has helped to compare the effectiveness of these treatments and provide solid level 1 evidence and data to back up treatment decisions.

For the many eyes with DME that present with good visual acuity (VA), data has shown that similar visual outcomes can be achieved with a number of approaches. “All 3 treatment approaches seem to work pretty well for these eyes,” said Dr Ip, “and I think it’s a situation where you can individualize [your] approach with each patient.”

The benefit of anti-VEGF therapy in certain subset populations, including those with center-involve DME with good VA, has not yet been evaluated.

During the question-and-answer portion of the presentation, Dr Ip said that he personally uses aflibercept as the first-line anti-VEGF therapy for DME since the overall clinical trial comparison showed it to be better than the other 2 drugs. If a patient has access issues or something preventing them from using aflibercept, he will consider the other options.

Dr Ip concluded that the management of DME with anti-VEGF therapy is different than in other disorders like wet-AMD, saying that “It tends to be a little slowed.” Typically, 9 to 10 injections are needed in the first year, with the amount needed dropping in subsequent years.

A potential new treatment for DME is brolucizumab (Beovu), which recently demonstrated positive topline results from a second phase III trial in patients with DME. In the study, brolucizumab achieved non-inferiority to aflibercept in change in best-corrected visual acuity at 52 weeks.

Faricimab, a bispecific antibody, is also being evaluated in DME. In the YOSEMITE and RHINE studies, faricimab (Genentech) demonstrated non-inferior visual acuity gains when given every 8 weeks and at personalized dosing intervals of up to 16 weeks compared to aflibercept given every 8 weeks. Treatment was generally well-tolerated. In patients receiving faricimab at personalized dosing intervals, more than half achieved an extended time between treatments of 16 weeks at year one.

Ip M, et al. Diabetic Macular Edema: Update on Current Treatment Approaches in 2021. Presented at: Hawaiian Eye and Retina 2021.

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