Abstract
Purpose :
To investigate the rate of responders and non-responders to anti-vascular endothelial growth factor (VEGF) intravitreal therapy for diabetic macular edema (DME) in patients treated with systemic renin-angiotensin-aldosterone system (RAAS) antagonists and controls.
Methods :
This retrospective study was approved by the IRB at the Illinois Eye and Ear Infirmary. We reviewed medical records of patients ≥18 years of age or older with a diagnosis of Diabetes Mellitus (type 1 or 2), clinically significant DME, macular edema in optical coherence tomography with of central retinal thickness (CRT) ≥ 275 µm, treated with intravitreal anti-VEGF drugs (bevacizumab, ranibizumab, aflibercept). Response to anti-VEGF was calculated as a ≥ 20% reduction of the baseline CRT.
Results :
A total of 268 patients were included. Of these patients, 113 patients received bilateral injections and 155 unilateral. In the RAAS group, 54/117 patients (46.6%) were male while 78/151 (48.3%) in controls. Mean age at presentation was 60.29 ± 9.87 years for RAAS patients and 50.01 ± 12.46 years for controls. No significant racial/ethnic differences were observed between these groups. Hypertension and dyslipidemia were significantly more frequent in the RAAS group (p < 0.001, Fisher’s Exact Test). However, baseline CRT was lower in the RAAS group in patients who received bevacizumab/ranibizumab yet not in those receiving aflibercept (p = 0.046, vs controls, T-test for independent samples). However, the rate of late responders to aflibercept injections at 1 year was lower in the RAAS group (9.09%) compared to controls (46.15%), (p = 0.046, Chi-square test). Differences between these groups were not significant for the bevacizumab/ranibizumab treatments (p = 0.502).
Conclusions :
DME patients who receive RAAS antagonists show an early lower baseline CRT yet a lower late response rate to aflibercept at 1 year. RAAS pathway antagonists may affect the response rate to anti-VEGF drugs in diabetic patients with DME. Further randomized control clinical trials are required to further elucidate these findings.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.