Persistent Diabetic Macular Edema: Converting Eyes to Aflibercept

by: Alexander M Castellino, PhD
Resistant diabetic macular edema may necessitate transitioning from one intravitreal pharmacotherapy to another when the edema is persistent — a practice sometimes undertaken in clinical management.
Now a new report describes an initial experience converting from therapy with ranibizumab (Lucentis, Genentech) or bevacizumab (Avastin, Genentech) to aflibercept (Eylea, Regeneron). Although only a small study — researchers included 50 eyes of 37 patients — this practice led to significant anatomical improvement in the macular edema but did not significantly improve visual acuity or reduce intraocular pressure in the short term.
The work is published in the April issue of the American Journal of Ophthalmology by Ehsan Rahimy, MD, of the Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, and colleagues.
Switching From Older VEGF Inhibitors to Newest
Ranibizumab, bevacizumab, and aflibercept are three vascular endothelial growth factor (VEGF) inhibitors that are injected intravitreally and are used for the clinical management of diabetic macular edema (although bevacizumab is not actually approved for this ophthalmic indication, this cancer drug is widely used off label for this purpose, mainly because it is considerably cheaper than the other two).
VEGF inhibitors revolutionized how this condition is treated, and all three agents have been shown to improve vision to a similar degree in eyes with center-involved diabetic macular edema in head-to-head trials when baseline visual-acuity loss is mild. But there is a suggestion that aflibercept, the newest drug, is more effective in patients with worse levels of initial visual acuity.
Senior author of the new study, Jason Hsu, MD, of the Retina Service of Wills Eye Hospital, toldMedscape Medical News that this latest research “primarily looked at the effect of switching from the older VEGF inhibitors to the newest one.”
He added that improvements in macular edema have been seen when patients with wet age-related macular degeneration were switched to aflibercept, and so his team wanted to know whether this “would also be reflected in the setting of persistent diabetic macular edema.”
“This study offers potentially useful clinical insight into the initial experience with aflibercept in managing diabetic macular edema in a ‘real-world’ setting, where patients have been previously treated with other VEGF inhibitors,” he and his colleagues note in their paper……
Read more: http://www.medscape.com/viewarticle/863069
Source: Medscape

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