VA less improved in Black patients with DME after anti-VEGF treatment
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Black patients with diabetic macular edema demonstrated significantly less visual acuity improvement following intravitreal bevacizumab treatment than did white and Hispanic patients, according to a study.
“This is an important finding because diabetic macular edema is twice as likely to affect Black individuals than white individuals,” study co-author Manju L. Subramanian, MD, told Healio/OSN.
The retrospective cohort study directly examined race and ethnicity as a factor impacting DME treatment response to Avastin (bevacizumab, Genentech).
Researchers evaluated percentage of patients with visual acuity improvement and a mean percentage reduction in central macular thickness. Data were collected from 314 patients who received a single injection and 151 patients who received three injections. After a single injection of bevacizumab, visual acuity improved at least 0.1 logMAR in 26.7% of Black patients, 39.4% of Hispanic patients and 50% of white patients. After three injections, visual acuity improved at least 0.1 logMAR in 33.8% of Black patients, 54.76% of Hispanic patients and 58.5% of white patients.
“The gap in treatment means that we are treating Black individuals, who have a higher incidence of DME, with a drug that is more effective in a population of whites and Hispanics who have a relatively lower incidence of the same disease,” Subramanian said.
The results demonstrate the need for increased diversity when recruiting for clinical trials, she said.
Further studies also need to be completed to determine whether the same effect exists long-term, after 1 or 2 years of treatment, and whether other treatments for DME such as Eylea (aflibercept, Regeneron) or Lucentis (ranibizumab, Genentech) show the same level of racial disparity, she said.
It can be challenging to recruit Black individuals into research because of fear and mistrust.
“But these challenges can be addressed, and study recruiters can be educated and trained on how to alleviate fear and gain trust among study participants. Here at Boston University Medical Center, we are fairly successful in recruiting Black and Hispanic individuals into clinical studies although not to the same degree as white individuals,” she said.
Perspective
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The authors should be congratulated in evaluating these findings. Although it is clear that minorities and people of specific racial status are at greater risk of developing diabetic macular edema, it is unclear the extent to which these high-risk groups experience a difference in follow-up treatment post-diagnosis of DME. This study helps to characterize those differences. However, race alone can be confounded with other socioeconomic factors and access to care to magnify this problem. It will be interesting to see if these short-term differences in outcome relate to long-term outcomes in diabetic retinopathy management and the rates of legal blindness.
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