July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Association of Early Response to Anti-VEGF Injections for Diabetic Macular Edema with Visual Outcomes Two Years Later: Post-hoc Analysis of DRCR.net Protocol T
Author Affiliations & Notes
  • Adam R Glassman
    Jaeb Center for Health Research, Tampa, Florida, United States
  • Footnotes
    Commercial Relationships   Adam Glassman, None
  • Footnotes
    Support  : Supported through a cooperative agreement from the National Eye Institute and the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland (grants: EY14231, EY14229, and EY18817). Regeneron Pharmaceutical provided the aflibercept and Genentech provided the ranibizumab for the study. Genentech also provided funding for the plasma collection from this ancillary study. As per the DRCR.net Industry Collaboration Guidelines (available at www.drcr.net), the DRCR.net had complete control over the design of the protocol, ownership of the data, and all editorial content of presentations and publications related to the protocol. The funding organization (National Institutes of Health) participated in oversight of the conduct of the study and review of the manuscript but not directly in the conduct of the study, nor in the collection, management, or analysis of the data. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 4824. doi:
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    • Get Citation

      Adam R Glassman; Association of Early Response to Anti-VEGF Injections for Diabetic Macular Edema with Visual Outcomes Two Years Later: Post-hoc Analysis of DRCR.net Protocol T. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4824.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Assess association of visual acuity outcomes at 2 years with visual acuity and optical coherence tomography (OCT) central subfield thickness (CST) at 12 weeks following anti-VEGF treatment for diabetic macular edema (DME).

Methods : Post-hoc analyses of DRCR.net Protocol T. Eyes received monthly anti-VEGF injections (unless success after 3 to 5) after randomization to 2.0-mg aflibercept, 1.25-mg bevacizumab, or 0.3-mg ranibizumab; subsequent injections or focal/grid laser or both were given as needed per protocol.

Results : Visual acuity response at 12 weeks was associated with change in visual acuity from baseline at 2 years in each treatment group (multivariable P<.001). However, there was substantial individual variability, which precluded confident prediction of subsequent outcomes based on the 12-week response. For example, among eyes with <5-letter gain from baseline at 12 weeks, 20/48 (42%), 21/68 (31%), and 28/59 (47%) eyes in the aflibercept, bevacizumab, and ranibizumab groups, respectively, gained 10 or more letters from baseline at 2 years. Central subfield thickness response at 12 weeks was not as strongly associated with 2-year change in visual acuity. Among eyes with <10% vs. ≥20% CST decrease at 12 weeks, the number of eyes gaining 10 or more letters of vision at 2 years was 18/32 (56%) vs. 74/112 (66%) in the aflibercept group, 28/71 (39%) vs. 45/68 (66%) in the bevacizumab group, and 25/43 (58%) vs. 59/95 (62%) in the ranibizumab group.

Conclusions : Following three consecutive anti-VEGF injections for DME, visual acuity response at 12 weeks was associated with 2-year change in visual acuity, but with substantial individual variability. However, up to half of eyes with <5-letter gain at 12 weeks gained 10 or more letters from baseline at 2 years. Until the risks and benefits of specific alternative therapies have been clearly established, these data suggest that caution should be advised before considering alternative treatments 12 weeks after initiating anti-VEGF therapy for DME.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

 

Mean change in visual acuity (VA) letter score at 2 years for eyes gaining < 5 letters at 12 weeks.

Mean change in visual acuity (VA) letter score at 2 years for eyes gaining < 5 letters at 12 weeks.

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