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Prospective trial compares treatments in matched DME eyes of poor anti-VEGF responders
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FLORENCE, Italy — A small prospective trial comparing the effect of two drugs showed better results with a dexamethasone implant than monthly ranibizumab when the same patient with diabetic macular edema previously did not respond well to ranibizumab.
Eleven patients were included. They were stable, chronic patients with well-controlled diabetes, equal diabetic retinopathy and macular edema in both eyes, and a symmetric history of consistent anti-VEGF treatment every 4 to 6 weeks with suboptimal success and persistent DME, Tarek Hassan, MD, said at the FLOREtina meeting.
Tarek Hassan
In the study, one eye continued Lucentis (ranibizumab, Genentech/Novartis) monthly for 3 months and one eye switched to treatment with one dexamethasone implant.
“Visual acuity improvement was comparable at 2 and 3 months, but better at 1 month in the dexamethasone eye. Reduction of foveal thickness was better throughout the study with the dexamethasone implant, particularly significant at month 2. This in spite of the ranibizumab eye getting a consistent dose every month,” Hassan said.
At month 4, patients were offered the choice of what to do next. Eight patients asked for dexamethasone in both eyes, two continued with the same regimen, and one switched treatment between eyes. None of the patients wanted ranibizumab in both eyes.
IOP was minimally higher with dexamethasone. In two cases it increased above 30 mm Hg, needing medical treatment in one case. Both eyes returned to normal IOP at month 3. – by Michela Cimberle
Disclosure: Hassan reports he is a consultant to Allergan, Genentech, Roche, Regeneron and Novartis.