Anti-VEGF therapy can improve diabetic retinopathy
medwireNews: A substantial proportion of diabetes patients experience improvements in diabetic retinopathy while receiving anti-vascular endothelial growth factor (VEGF) treatment, shows the latest analysis from DRCR.net.
The improvements were broadly similar with the three different anti-VEGF agents, although patients with proliferative diabetic retinopathy appeared to do better with aflibercept than with ranibizumab or bevacizumab.
Over the 2 years of follow-up, only a small proportion of patients had worsening of their retinopathy, with rates of 10.2% for those receiving aflibercept and bevacizumab and of 7.1% for those receiving ranibizumab, report Danni Liu (Jaeb Center for Health Research, Tampa, Florida, USA) and team in JAMA Ophthalmology.
In a commentary accompanying the study, Shriji Patel and Paul Sternberg Jr, both from Vanderbilt Eye Institute in Nashville, Tennessee, USA, say: “The implications of these findings cannot be overstated. Prior to the advent of anti-VEGF therapy, our options for delaying [diabetic retinopathy] progression were limited.”
At 1 year of follow-up, the rate of improvement among patients with nonproliferative retinopathy at baseline was significantly better with aflibercept and ranibizumab, at 31.2% of 141 treated eyes and 37.7% of 151 treated eyes, respectively, than with bevacizumab, at 22.1% of 131 treated eyes. But by year 2, there were no significant differences between the improvement rates, at a corresponding 24.8%, 31.0%, and 22.1%.
Patients who had proliferative diabetic retinopathy at baseline had generally worse outcomes than the other patients, with between 17.2% and 26.4% of eyes progressing by the 2-year mark. However, 75.9% of 29 eyes treated with aflibercept improved at 1 year, which was significantly greater than the 55.2% of 29 eyes treated with ranibizumab and the 31.4% of 35 eyes treated with bevacizumab, and the difference was maintained at 2 years.
Among patients with nonproliferative retinopathy, the likelihood of improvement rose in line with the number of injections received, which Patel and Sternberg Jr note suggests a dose–response effect.
Reconciling this with the finding that some patients’ retinopathy deteriorated despite treatment “involves acknowledging that a number of factors, including anti-VEGF agent selection, combine to influence progression and regression of [diabetic retinopathy],” they say.
They write: “As we know from long-term diabetic trials, systemic factors, such as glycemic control and comorbidities, play an important role in the progression or regression of [diabetic retinopathy].
“Regardless of the local control we can supply via serial anti-VEGF injections, the patient’s role in their diabetes management will always be pinnacle.”
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