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DRCR.net subgroup analysis: Long-term anti-VEGF decreases rate of chronic persistent DME
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BOSTON — Continuing anti-VEGF treatment longer than 6 months decreased the rate of chronic persistent diabetic macular edema and slowed vision loss, according to a study presented here.
At Macula 2015, Neil M. Bressler, MD, discussed a subgroup analysis of data culled from the DRCR.net Protocol I clinical trial.
“The question is … do you keep treating with anti-VEGF and what happens if you don’t?” Bressler said. “We didn’t in the [DRCR.net trial.] The network said, ‘If you reach a point of stability by that point, stop, and only resume treatment if it starts to worsen again.’ So, we left a lot of eyes with thickening on the table.”
The analysis included 344 eyes; 318 (93%) had at least four of a maximum of six injections before week 24.
Persistent central-involved DME was detected in 117 patients (32%). Laser photocoagulation was given if DME worsened.
Eyes with persistent DME at 24 weeks were considered to have “chronic persistent DME” until they had a central subfield thickness of less than 250 µm.
Eighty percent of eyes had chronic persistent DME at 1 year, 60% at 2 years and 40% at 3 years.
Median visual acuity was 20/50 at baseline and 20/40 at 24 weeks.
At 1 and 2 years, median visual acuity was 20/32 in eyes with and without chronic persistent DME. At 3 years, median visual acuity was 20/32 in eyes with chronic persistent DME and 20/25 in eyes without chronic persistent DME.
“There is a better VA outcome if you have chronic persistent DME and it went away,” Bressler said. “Don’t give up on these eyes. Follow them, but we don’t necessarily see any indication to treat them differently yet because most of them did not have substantial vision loss.”
The mean number of injections from 24 weeks to 52 weeks was five in eyes with and without chronic persistent DME. From 52 weeks to 104 weeks, the mean number of injections was five in eyes with chronic persistent DME and two in eyes without chronic persistent DME. From 104 weeks to 3 years, the mean number of injections was three in eyes with chronic persistent DME and two in eyes without chronic persistent DME.
Disclosure: Bressler has received grant support from Bayer, Genentech, Novartis and Regeneron.