Model shows early treatment of severe diabetic retinopathy reduces incidence of advanced stage, blindness
A simulation model suggests that treating severe non-proliferative diabetic retinopathy (NPDR) early with anti-vascular endothelial growth factor (anti-VEGF), rather than delaying treatment until proliferative diabetic retinopathy (PDR) develops, could significantly reduce the incidence of PDR over 5 years and decrease the risk of sustained blindness over 10 years, according to a study.
The research team constructed a comprehensive simulation model using data from a retrospective real-world cohort of treatment-naive patients identified in an electronic medical records database. The impact of anti-VEGF treatment was determined from clinical trial data on intravitreal aflibercept (PANORAMA) and ranibizumab (RISE/RIDE), which were averaged based on their weighted market share in the United States. The risk of PDR progression in real-world settings was modeled using Cox multivariable regression analysis.
The Monte Carlo simulation model examined the rates of progression to PDR and sustained blindness (visual acuity below 20/200) for 2 million patients, which was scaled to the prevalence of NPDR disease in the United States. By comparing delayed treatment with early treatment, the researchers assessed the simulated progression rates from severe NPDR to PDR over 5 years and blindness rates over 10 years.
The results of the study demonstrated that early treatment of severe NPDR with anti-VEGF therapy resulted in a 51.7% relative risk reduction in PDR events over 5 years. Specifically, there were 15,704 PDR events in the early treatment group compared to 32,488 events in the delayed treatment group. In addition, an absolute risk reduction of 19.4% was observed, with PDR events occurring in 18.1% of the early treatment group versus 37.5% of the delayed treatment group. The sustained blindness rates at 10 years were 4.4% for the delayed treatment group and 1.9% for the early treatment group.
Nguyen QD, Moshfeghi AA, Lim JI, et al. Simulation of long-term impact of intravitreal anti-VEGF therapy on patients with severe non-proliferative diabetic retinopathy. BMJ Open Ophthalmol. 2023;8(1):e001190. doi: 10.1136/bmjophth-2022-001190. PMID: 37278412.