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Ozurdex works as adjunct treatment in diabetic macular edema
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Patients with diabetic macular edema recalcitrant to anti-VEGF therapy and then treated with an intravitreal sustained-release 0.7 mg dexamethasone implant as part of a multimodal treatment experienced significant gains in visual acuity at a mean follow-up of 6 months, according to a study.
DME is a multifaceted disease with ischemic and inflammatory mechanisms that can be treated with Ozurdex (dexamethasone intravitreal implant, Allergan), Zainab Khan, BHSc, MD, FRCSC, told Ocular Surgery News.
“Ozurdex can also provide an additive or synergistic effect when using the two [Ozurdex and anti-VEGF] in combination. It is well-tolerated with a good side effect profile, which makes it great for patients to use,” Khan said.
Gain in visual acuity
Khan and colleagues conducted a meta-analysis that included 3,859 patients in 15 studies (three randomized control trials, six retrospective studies and six prospective observational studies) and evaluated the mean difference in best corrected visual acuity from baseline to a mean follow-up of 6 months. All patients included in the study were treated with at least six prior intravitreal treatments of anti-VEGF therapy.
Patients treated with Ozurdex for DME refractory to anti-VEGF therapy gained a mean of four lines, or 20 ETDRS letters, at 6-month follow-up, Khan said. LogMAR BCVA improved throughout all 15 of the studies.
Khan said multiple modalities should be considered by physicians to treat cases of DME.
“Combination treatment likely yields better outcomes. This approach also reduces the overall treatment burden by resulting in fewer injections over time. Ozurdex is effective also in recalcitrant cases. One approach we have found helpful is to switch to steroids before switching to another anti-VEGF agent. At a molecular level this is because steroids block different receptors compared to anti-VEGF,” she said.
Begin treatment early
Ozurdex should be considered early in the treatment plan in a combination therapy approach with anti-VEGF or laser. Data show that after three anti-VEGF injections, physicians can typically predict the patient’s response to future injections, Khan said.
“A significant advantage for our patients is the overall decrease in treatment burden as well as good gains in vision. There is a significant paradigm shift in research demonstrating that DME is not only a problem resulting from VEGF, but that it also has a highly inflammatory component. Ozurdex is better able to address this than anti-VEGF. Furthermore, the biopharmacokinetics enable a sustained release agent that patients tolerate quite well,” she said.
Khan and colleagues wrote in the study that the findings were limited by “a relatively high heterogeneity within the chosen studies.” Heterogeneity is expected, though, until there are more studies available that discuss the effect of Ozurdex on DME refractory to anti-VEGF therapy. – by Robert Linnehan
- Reference:
- Khan Z, et al. Ophthalmic Surg Lasers Imaging Retina. 2017;doi:10.3928/23258160-20170130-10.
- For more information:
- Zainab Khan, BHSc, MD, FRCSC, can be reached at Department of Ophthalmology, Queen’s University, 99 University Ave., Kingston, ON K7L 3N6, Canada; email: zkhan@qmed.ca.
Disclosure: Khan reports no relevant financial disclosures.