Healio
Healio
April 27, 2017
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Secondary analysis of DRCR.net Protocol T compares improvement and worsening rates over 2 years

A secondary analysis of DRCR.net Protocol T data demonstrated significant, sustained improvement rates of both nonproliferative and proliferative diabetic retinopathy at 1 and 2 years with all three anti-VEGF agents, low rates of worsening and relatively better performance of aflibercept.

A total of 650 participants were analyzed, 495 with nonproliferative DR and 155 with proliferative DR. Both groups were reduced in number during the course of the study to comply with the study criteria. Improvement and worsening at 1 and 2 years were evaluated by fundus photography according to ETDRS classification levels.

In the nonproliferative DR group, an improvement of two or more levels on the ETDRS scale was obtained with all three anti-VEGF agents, but Avastin (bevacizumab, Genentech) had a lower improvement rate as compared with Eylea (aflibercept, Regeneron) and Lucentis (ranibizumab, Genentech) at 1 year. At 2 years, results were not different among the three agents. In the proliferative DR group, aflibercept obtained significantly higher improvement rates.

According to the authors, the better performance of aflibercept in eyes with proliferative DR was consistent with other findings within the same trial, in which “among eyes with more severe disease ... aflibercept had more favorable VA and anatomic outcomes, particularly at 1 year.”

Independent of the anti-VEGF agent, a correlation between the number of injections and improvement rate was found in the nonproliferative DR group but not in the proliferative DR group.

Worsening rates were small in both groups. “Nevertheless, some patients receiving anti-VEGF therapy for DME experience worsening of DR, warranting regular surveillance,” the authors noted. – by Michela Cimberle

Disclosure: Bressler reports she has received grants from the National Institutes of Health, Genentech/Roche, Regeneron, Bayer, Boehringer Ingelheim, Notal and Novartis. Please see the study for all other authors’ relevant financial disclosures.

Sources/Disclosures

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Source:

Bressler SB, et al. JAMA Ophthalmol. 2017;doi:10.1001/jamaophthalmol.2017.0821.