June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Early Switch to the Dexamethasone Implant after Sub-Optimal Response to Anti-VEGF Therapy for Diabetic Macular Edema
Author Affiliations & Notes
  • Shaheen Kavoussi
    Ophthalmology, Houston Methodist, Houston, Texas, United States
    Ophthalmology, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States
  • Joseph Nezgoda
    West Boca Eye Center, Florida, United States
  • Jay Chhablani
    University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Daniel F Kiernan
    Ophthalmic Consultants of Long Island, New York, United States
  • Seenu Hariprasad
    University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
  • Sonny Caplash
    University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Joseph N Martel
    University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Michael Singer
    Medical Center Ophthalmology Associates, Texas, United States
  • Footnotes
    Commercial Relationships   Shaheen Kavoussi, Abbvie, Inc. (C), Abbvie, Inc. (R); Joseph Nezgoda, Abbvie, Inc. (C), Genentech (C), Genentech (R), Novartis (C), Novartis (R); Jay Chhablani, Abbvie, Inc. (C), Biogen (C); Daniel Kiernan, Abbvie, Inc. (F), Abbvie, Inc. (C), Abbvie, Inc. (R), Regeneron (C), Regeneron (R); Seenu Hariprasad, Abbvie, Inc. (C), Alimera Sciences (C), Bausch & Lomb (C), Biogen (C), Clearside Biomedical (C), EyePoint Pharmaceuticals (C), Regeneron (C), Spark Therapeutics (C); Sonny Caplash, None; Joseph Martel, None; Michael Singer, Abbvie, Inc. (C), Abbvie, Inc. (R), Abbvie, Inc. (F), Aerie Pharmaceuticals (C), Aerie Pharmaceuticals (F), Allegro (C), Allegro (F), Eyepoint (C), Genentech (R), Genentech (C), Genentech (F), Icon (F), Ionis (F), Kalvista (F), Kodiak (C), Kodiak (F), Mallinckrodt (R), Novartis (C), Novartis (R), Novartis (F), Opthea (F), Optos (F), Regeneron (C), Santen (C), Spark Therapeutics (R)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 1053. doi:
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      Shaheen Kavoussi, Joseph Nezgoda, Jay Chhablani, Daniel F Kiernan, Seenu Hariprasad, Sonny Caplash, Joseph N Martel, Michael Singer; Early Switch to the Dexamethasone Implant after Sub-Optimal Response to Anti-VEGF Therapy for Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1053.

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

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Abstract

Purpose : In DRCR Protocol I Early Analysis, 26% of patients were non-responders to anti-vascular endothelial growth factor monotherapy, but visual gains with steroid switch therapy in Protocol U were limited by duration of diabetic macular edema (DME). Study of an earlier multi-factorial approach is indicated. This study assesses treatment for DME with the dexamethasone 0.7 mg implant (DEX) after limited response to 1-3 monthly anti-vascular endothelial growth factor injections (AVF).

Methods : This multi-center, retrospective series included 58 initially treatment-naïve patients with < 200 um reduction in central retinal thickness (CRT) and/or < 5 Early Treatment Diabetic Retinopathy Study (ETDRS) letters gained after 1-3 intravitreal bevacizumab or aflibercept AVF, who were then switched to DEX with ≥ 6 weeks subsequent follow-up.

Results : Baseline mean ± standard deviation (SD) best-corrected visual acuity (BCVA) was 55 ± 14 letters. CRT was 453 ± 172 microns. After patients received one (26%), two (6%) or three (68%) monthly AVF, mean BCVA was 57 ± 14 letters (p=0.57) and CRT was 412 ± 134 um (p=0.16). After subsequent DEX, BCVA was 65 ± 13 letters (p=0.0001 compared to baseline and p=0.003 compared to post-AVF) and CRT was 280 ± 57 um (p<0.0001 compared to both baseline and post-AVF).

Conclusions : In this cohort, patients with DME who had a limited visual and anatomic response to 1-3 monthly doses of either intravitreal bevacizumab or aflibercept demonstrated significant improvements after subsequent treatment with the dexamethasone 0.7 mg implant. Earlier intervention with DEX for treating DME may result in more rapid visual and anatomic gains compared to AVF monotherapy in certain patients.

This is a 2021 ARVO Annual Meeting abstract.

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