Two-Year Clinical Data of Preventative Intravitreal Anti-VEGF for Treatment of Diabetic Retinopathy

Article: Preventive treatment reduces diabetic retinopathy complications
Source: National Eye Institute
Published: March 30, 2021

A randomized clinical trial funded by the National Eye Institute and published in JAMA Ophthalmology  recently provided two-year data of the effect of early treatment with intravitreal anti-VEGF (anti-vascular endothelial growth factor) aflibercept (Eylea) for the prevention of vision-threatening complications of diabetic retinopathy. As part of a four-year randomized clinical trial, this study is conducted at 64 U.S. and Canadian sites and involves 328 adults (399 eyes) with moderate to severe non-proliferative diabetic retinopathy (NPDR), without center-involved diabetic macular edema (CI-DME). Study protocols were followed to ensure that any patient who developed CI-DME with vision loss or high-risk proliferative diabetic retinopathy (PDR) received aflibercept. The results at the halfway mark showed that treatment with periodic aflibercept reduced rates of PDR and DME. In particular, the rate of PDR development was 14% in the treatment group compared to 33% in the control group. Similarly, the rate of development of vision-threatening DME was 4% in the treatment group compared to 15% in the control group. However, change in visual acuity was essentially the same for both groups (6 letters lost) at two years. In other words, preventative treatment did not confer visual benefit compared to the current standard practice of treatment with anti-VEGF only after development of PDR or vision-threatening CI-DME. Just as it is valuable to discover new treatment guidelines that are effective, it is equally important to discover when new treatment strategies do not confer substantial benefit. The four-year results will provide further information on the longer-term effects of preventative treatment in this study.

My rating of this study: ⭐⭐⭐

Maturi RK, Glassman AR, Josic K, et al. "Effect of Intravitreous Anti–Vascular Endothelial Growth Factor vs Sham Treatment for Prevention of Vision-Threatening Complications of Diabetic Retinopathy." JAMA Ophthalmology.  Published online 30 March 2021. https://doi.org/10.1001/jamaophthalmol.2021.0606