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Retina

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

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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 2nd 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.

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