The effect of diabetic macular edema treatment on diabetic retinopathy progression: Real-world data from 27 UK hospitals

Abstract

Purpose : Treatment of diabetic macular edema (DME) with anti-vascular endothelial growth factor (Anti-VEGF) injections can improve the severity of diabetic retinopathy (DR). However, little is known about the effect and durability of these agents on DR grading outside of clinical trials. This study aims to explore the development of proliferative DR (PDR) during and after treatment of DME with anti-VEGF injections from a large multi-centre database.

Methods : Data from 27 UK centres using the same electronic medical record system were remotely extracted. The analysis was restricted to eyes that received anti-VEGF agents for DME between February 2013 and December 2018. The primary outcome was the time from first DME treatment (DR grade prior to first treatment) until progression to PDR. Time-to-event analysis was done to demonstrate the rate of progression to PDR stratified by baseline DR grade.

Results : A total of 4 922 patients (58.2% male) were included. Mean age (standard deviation [SD]) was 66.41 (11.90) years and mean(SD) follow-up was 13.07 (15.29) months. On average, each patient received 6.29 (SD 6.3) anti-VEGF injections during this period. More severe DR grades required a higher number of injections; 5.81 injections for grade 1 (Mild non-proliferative DR[NPDR]), 6.56 and 6.84 injections for grade 2 (moderate NPDR) and grade 3 (severe NPDR), respectively. Kaplan-Meier survival curves showed that progression to PDR was strongly influenced by the baseline DR grade (Fig. 1). Controlling for the baseline DR grade, a higher number of injections (>6 compared to 6 injections or less) didn’t confer a lower risk of PDR development.

Conclusions : This is the largest cohort of DME patients who received anti-VEGF injections and were evaluated for PDR development. Baseline DR grade is an important influential factor for PDR development during DME treatment. Moreover, DR improvement in clinical trials may not be reproduced in routine care settings where patients receive fewer treatments and could have less rigorous diabetes mellitus control. This will help inform clinicians about the importance of carefully following these patients and adjusting their follow-up intervals accordingly.

This is a 2021 ARVO Annual Meeting abstract.

 

The cumulative probability of PDR development among different baseline grades of diabetic retinopathy. Around 85% of patients with grades 1 & 2 were PDR-free at 2 years compared to 75% of grade 3 patients.