Effect of systemic factors on clinical response to endothelial growth factor therapy for diabetic macula edema: a real-life experience

Abstract

Purpose : Purpose: Multiple studies have shown that glycosylated hemoglobin (HbA1c) level and estimated glomerular filtration rate (eGFR) increase the risk of DME but controversy exists regarding the impact on the response to anti-VEGF treatment. We tested the hypothesis that baseline HbA1c level and GFR have an effect on visual and anatomic outcomes in patients with DME receiving anti-VEGF injections (Ranibizumab or Aflibercept) in routine clinical practice with a retrospective analysis of data from the prospectively designed, multi-centre, observational Fight Retinal Blindness! registry.

Methods : Methods: We included 178 eyes with DME treated with anti-VEGF agents from January 1, 2010 to March 31, 2019 to allow up to 24 months of follow-up. Data for eyes were tracked in the Fight Retinal Blindness! registry and clinical parameters were collected with local software. The main outcome measures were changes in visual (best corrected visual acuity [BCVA], in letters) and anatomic outcomes (central subfield thickness [CST], in microns) between subgroups of baseline HbA1c level≤ 7% versus > 7% and GFR > or ≤ 60 ml/min/m2 at 24 months.
Multivariate linear regressions adjusted for BCVA change and CST change were performed.

Results : Results: The multivariate adjusted mean improvement in BCVA 24 months after starting treatment was +5.2 and +6.8 letters with baseline HbA1c level≤ 7% and > 7% (p=0.541) and +6.9 and +6.4 letters with GFR > 60 and < 60 ml/min/1.73m2 (p=0.852). The multivariate adjusted mean CST reduction was -89.9 and -76.4 µm with baseline HbA1c level≤ 7% and > 7% (p=0.505) and -85 and -115 µm with baseline GFR> 60 and ≤ 60 ml/min/1.73m2 (p=0.130).

Conclusions : Conclusions: The visual and anatomical improvement in patients receiving intravitreal VEGF inhibitors for DME seems independent of baseline HbA1c level and GFR in daily practice.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.