Retinal nonperfusion increases despite improvement in DR severity scores after aflibercept therapy

The majority of patients with diabetic retinopathy (DR) treated with aflibercept (Eylea; Regeneron) had an improvement in DR severity scale (DRSS) levels from baseline through 2 years, despite experiencing significant increases in retinal nonperfusion (RNP), a biomarker for DR, according to the results of a study.

In this prospective, randomized clinical trial, eyes with PDR and RNP were randomized to receive intravitreal 2-mg aflibercept monthly (Arm 1) or quarterly (Arm 2) at baseline with treatment cross-over in 2^nd year.

The mean RNP increased from 235 mm² to 402 mm² (P < 0.0001) amongst all patients from baseline to year 2. ISI also increased from 25.8% to 50.4% (P <0.0001).

From year 1 to year 2, there was also an increase in mean RNP (P <0.0001) and ISI (P <0.0001)

In patients receiving monthly aflibercept, there was a mean total RNP increase from 264 mm² at baseline to 386 mm² at year 2. In patients receiving quarterly aflibercept, the increase was 207 mm² to 421 mm². Increases in mean RNP for each group were observed specifically within year 2 (P=0.32, monthly vs quarterly).

At the end of year 2, DRSS scores improved in 82% of patients compared to baseline scores and remained stable in 18%. No patients experienced worsening.

DRSS scores had improved by 2 or more steps at year 2 in 65% of patients receiving monthly aflibercept and 81% of patients receiving quarterly aflibercept.

Reference
Wykoff CC, Nittala MG, Boone CV, et al; RECOVERY Study Group. Final Outcomes from the Randomized RECOVERY Trial of Alfibercept for Retinal Nonperfusion in Proliferative Diabetic Retinopathy. Ophthalmol Retina. 2022;S2468-6530(22)00086-0. doi: 10.1016/j.oret.2022.02.013. Epub ahead of print. PMID: 35257962.