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10 October 2021 | Issue #2
Dexamethasone may improve outcomes for DME Early treatment with dexamethasone appears to improve visual and anatomic outcomes in real world patients with suboptimal response to anti-VEGF for diabetic macular edema, said Dr. Shawn Kavoussi, retinal surgeon and founder of the Texas Retina Center. This was a multicenter, retrospective series that included 58 consecutive treatment-naïve patients with a < 200µm reduction in central retinal thickness (CRT) and/or < 5 ETDRS letters gain after 1-3 intravitreal bevacizumab or aflibercept; these patients were then switched to dexamethasone with ≥ 6 weeks subsequent follow-up.
New Findings in DR Could Unlock the Key to Better Treatments and Outcomes by Hazlin Hassan
R
esults from some of the latest studies on diabetic retinopathy (DR) were presented during a symposium on Day 1 of the American Society of Retina Specialists (ASRS 2021) Scientific Meeting on October 9.
High number of patients skip follow-ups Many patients with proliferative diabetic retinopathy (PDR) who are treated with anti-VEGF therapy and/or panretinal photocoagulation (PRP) in the United States are skipping their follow-up treatments. And when patients are lost to follow-up, the ideal care is not delivered and patients likely suffer irreversible vision loss, said Rahul Khurana, clinical associate professor in ophthalmology at the UCSF Medical Center, USA. To illustrate this point, Prof. Khurana shared the results of a study aimed at determining the incidence of loss to follow-up in patients with PDR who were treated with anti-VEGF injections and/ or PRP in the U.S. The retrospective
cohort analysis involved 102,867 eyes of patients with PDR identified from the national IRIS Registry. These patients were newly diagnosed between January 1, 2013 and December 31, 2015 and treated with anti-VEGF therapy and/ or PRP between January 1, 2013 and December 31, 2018. Loss to follow-up (LTFU) was defined as an interval greater than 12 months from the last treatment. Results showed that for PDR patients treated with anti-VEGF therapy alone, 10.7% of patients were LTFU. For PDR patients treated with PRP alone, 9.5% of patients were LTFU. For PDR treated with anti-VEGF and PRP, 9.8% of patients were LTFU. This shows a significant rate of LTFU after anti-VEGF injections and PRP among patients with PDR. Identified risk factors include: increasing age, male sex, African American and Hispanic ethnicity, unilateral involvement and private insurance. “Improving treatment adherence and follow-up is critical to prevent vision loss in PDR,” concluded Prof. Khurana.
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 dexamethasone for treating DME may result in more rapid visual and anatomic gains compared to AVF monotherapy in certain patients,” said Dr. Kavoussi.
Oral drug APX3330 safe for DR and DME APX3330, a novel oral drug in development for the treatment of DR, has demonstrated a favorable safety and tolerability profile in eleven phase 1 and 2 studies, said Dr. Michael Allingham, retinal specialist, Duke Eye Center, United States. APX3330 has an anti-angiogenic and anti-inflammatory mechanism relevant to the treatment of retinal disease. Safety data for the drug were collected from over 300 subjects receiving oral APX3330 in support of ZETA-1, an ongoing, randomized, placebo-controlled clinical trial evaluating the efficacy of 600mg/ day APX3330 for the treatment of DR and DME. “Currently, approved therapies targeting DR at the earlier stages require intravitreal injection, and thus, early non-invasive interventions targeting DR represent a clinical unmet need,” said Dr. Allingham. “APX3330 is a candidate to fill this niche.”