Aflibercept in diabetic macular edema refractory to previous bevacizumab: outcomes and predictors of success

Laiginhas, Rita; Silva, Marta Inês; Rosas, Vitor; Penas, Susana; Fernandes, Vítor; Rocha‐Sousa, Amândio; Carneiro, Ângela; Falcão‐Reis, Fernando; Falcão, Manuel

doi:10.1007/s00417-017-3836-1

Cited by 36 publications

(22 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is the first 2-year prospective study of aflibercept for DME conducted in a routine clinical situation in patients with no or minimal recent exposure to anti-VEGF treatment. The few clinic-based prospective T&E studies conducted to date have investigated the efficacy of bevacizumab [22] or ranibizumab [23][24][25], but most prospective studies have concentrated on the outcomes of aflibercept treatment in patients non-responsive to other anti-VEGF treatments [26][27][28][29] or using loading followed by an 8-weekly regimen [30], with results similar to that observed in the VIVA/VISTA.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of a Treat and Extend Regimen with Intravitreal Aflibercept Injections in Patients with Diabetic Macular Edema: Experience in Clinical Practice

Curry¹,

Sanfilippo

Chan

et al. 2019

Ophthalmol Ther

View full text Add to dashboard Cite

Introduction: Treat-and-extend (T&E) and pro re nata (PRN; 'as needed') regimens of intravitreal anti-vascular endothelial growth factor (VEGF) treatment have been found to reduce the injection burden on patients and improve the cost effectiveness of the treatment of macular edema. The aim of this study was to assess the effectiveness of a T&E regimen of aflibercept, in a clinical setting, in patients with diabetic macular edema (DME) who were either intravitreal anti-VEGF therapy naive or with minimal exposure to anti-VEGF (B 6 treatments) in the previous 12 months. Methods: This prospective, single arm, open label study recruited patients with DME (macular thickness of C 300 lm) and best-corrected visual acuity (BCVA) between 28-78 ETDRS letters. Participants received five loading doses of intravitreal aflibercept at 4-weekly intervals. BCVA measurements and macular optical coherence tomography were performed at each visit. If no disease activity was detected, treatment intervals were increased by 2 weeks to a maximum of 12 weeks. Outcome measures included: changes in BCVA and retinal anatomical measures (central foveal thickness [CFT] and central macular volume within 6 mm of the fovea [CSVol]) between baseline and 2 years, patient treatment intervals; and adverse events. Results: Of the 36 patients who provided informed consent to participate in the study and were screened, 26 patients (eyes) were eligible to participate in the study. After regression analysis, adjustment for repeated measures, and significant covariates, the mean BCVA increased by 3.8 letters (95% confidence interval [CI] 1.1, 6.4) and the CFT and CSVol decreased by 127.2 lm (95% CI 91.7, 162.5) and 1.6 mm 3 (95% CI 1.2, 2.0), respectively, over the course of the study. In the second year, 16 of the 25 patients still participating had their treatment intervals extended to 12 weeks. There was no evidence of any new adverse events that would require changes to the aflibercept safety profile.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of a Treat and Extend Regimen with Intravitreal Aflibercept Injections in Patients with Diabetic Macular Edema: Experience in Clinical Practice

Curry¹,

Sanfilippo

Chan

et al. 2019

Ophthalmol Ther

View full text Add to dashboard Cite

show abstract

“…An analysis of the DRCR.net protocol T study revealed that the incidence of persistent DME after 3 consecutive monthly injections was 50.8%, 53.2% and 72.9% through week 12, and 31.6%, 41.5% and 65.6% through week 24 in eyes that received aflibercept, ranibizumab and bevacizumab, respectively. Different treatment strategies have been proposed for PDME including switching to a different anti-VEGF agent, changing to intravitreal corticosteroid, focal laser treatment, and use of other adjunctive treatments like antioxidants [15,16,18,19]. There is increasing data in the literature that show continued treatment with the same anti-VEGF drug may lead to both functional and anatomical improvement in the longer term [10].…”

Section: Discussionmentioning

confidence: 99%

“…Centerinvolved DME was defined as central retinal thickness (CRT) ≥ 300 μm by Cirrus OCT (Carl Zeiss Meditec, Dublin, CA, USA) at the beginning of the study [4,15]. Diabetic eyes with evidence of residual intraretinal and/ or subretinal fluid and CRT on OCT > 300 μm after receiving loading doses of 3 monthly intravitreal anti-VEGF injections were considered to have PDME [16,17]. The final cohort included eyes that either continued the same initial anti-VEGF drug after they met previous criteria for PDME as group 1, and eyes with two successive cycles of switching anti-VEGF drugs (double anti-VEGF switch) as group 2.…”

Section: Methodsmentioning

confidence: 99%

Visual and anatomic outcomes of sustained single agent anti-VEGF treatment versus double anti-VEGF switching in the treatment of persistent diabetic macular edema

et al. 2020

View full text Add to dashboard Cite

Background: To compare the anatomical and visual outcomes in eyes with persistent diabetic macular edema (DME) after initial anti-VEGF therapy that were retreated continuously with the same anti-VEGF drug versus those that underwent two successive cycles of medication change in anti-VEGF drugs (double anti-VEGF switch). Methods: Retrospective review of eyes with persistent DME after 3 initial consecutive monthly anti-VEGF injections. This cohort was divided into two groups: Group 1 continued to receive the same initial anti-VEGF drug for at least 18 months while group 2 eyes were switched to different anti-VEGF medications twice. Group 1 was further subdivided into: Group 1A composed of eyes with less than 20% reduction in central subfield thickness (CRT) at month 3; and group 1B eyes with greater than or equal to 20% reduction in CRT. The percentage of eyes that achieved greater than 10 letters visual acuity (VA) gain or loss was recorded as the primary end point (through month 18 in group 1 and month 6 after 2nd switch in group 2). Results: Group 1A, 1B and group 2 were composed of 24, 18, and 14 eyes respectively. 34.7%, 56.2% and 36.3% of eyes achieved > 10 letters gain, while 4.3%, 6.2% and 27.2% of eyes lost > 10 letters in groups 1A, 1B, and 2, respectively. Analysis of the visual acuity (VA) letter change in this time interval revealed no significant difference between all groups (p = 0.11). Mean VA and CRT measurements at the primary endpoint in all groups were 0.5, 0.39, and 0.47 logMAR (p = 0.44), and 369.7, 279.9, 321 µm, (p = 0.01) respectively. Conclusions: There was no difference in the visual outcomes between the two treatment strategies in eyes with persistent DME after 3 consecutive anti-VEGF injections. This may indicate that anti-VEGF switching-even if it is done twice-may have comparable clinical outcomes to sustained treatment with one agent.

show abstract

“…In a retrospective study, 49 eyes from 34 patients with DME refractory to bevacizumab were treated with intravitreal aflibercept injection. 37 All patients had at least 3 intravitreal bevacizumab injections before switching to aflibercept, and all patients were followed-up for at least 3 months after switching. The mean visual acuity improved from 0.55 logMAR to 0.46 logMAR (P = 0.038), and the mean CMT decreased from 437 µm to 349 µm (P < 0.001).…”

Section: Anti-vegf Switchingmentioning

confidence: 99%

Management of Refractory Diabetic Macular Edema: A Review Article

Torabi

2018

Int J Med Rev

View full text Add to dashboard Cite

Diabetic retinopathy (DR) is a major cause of visual impairment worldwide. Visual reduction in patients with DR is usually related to diabetic macular edema (DME). Today, the intravitreal injection of anti-vascular endothelial growth factors (VEGF) is replacing macular laser photocoagulation as the standard treatment for DME; however, in some patients, incomplete responses to the anti-VEGF injection, defined as refractory DME, may occur. Currently, the sequence of using one treatment option and the timing to switch from one agent to another is not fully understood, and the data from clinical trials on the appropriate approach to manage refractory DME is insufficient. In the current study, a review was conducted to evaluate therapeutic options for the management of refractory DME.

show abstract

Aflibercept in diabetic macular edema refractory to previous bevacizumab: outcomes and predictors of success

Abstract: Conversion to aflibercept for persistent DME resulted in functional and anatomical improvements and these outcomes were not influenced by previous bevacizumab exposure. Pre-switch CMT was a predictor of anatomical changes after aflibercept.

Cited by 36 publications

References 25 publications

Clinical Outcomes of a Treat and Extend Regimen with Intravitreal Aflibercept Injections in Patients with Diabetic Macular Edema: Experience in Clinical Practice

Clinical Outcomes of a Treat and Extend Regimen with Intravitreal Aflibercept Injections in Patients with Diabetic Macular Edema: Experience in Clinical Practice

Visual and anatomic outcomes of sustained single agent anti-VEGF treatment versus double anti-VEGF switching in the treatment of persistent diabetic macular edema

Management of Refractory Diabetic Macular Edema: A Review Article

Contact Info

Product

Resources

About