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Translating evidence into practice: recommendations by a UK expert panel on the use of aflibercept in diabetic macular oedema

OBJECTIVES: This paper describes recommendations from a panel of UK retina experts on aflibercept in diabetic macular oedema (DMO). METHODS: A roundtable meeting was held in London, UK in March 2018. The meeting was sponsored by Bayer. RESULTS: Recommendations are based on clinical experience and le...

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Autores principales: Pearce, Ian, Bailey, Clare, Fletcher, Emily, Ghanchi, Faruque, Rennie, Christina, Santiago, Cynthia, Napier, Jackie, Yang, Yit
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182551/
https://www.ncbi.nlm.nih.gov/pubmed/31619777
http://dx.doi.org/10.1038/s41433-019-0615-8
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author Pearce, Ian
Bailey, Clare
Fletcher, Emily
Ghanchi, Faruque
Rennie, Christina
Santiago, Cynthia
Napier, Jackie
Yang, Yit
author_facet Pearce, Ian
Bailey, Clare
Fletcher, Emily
Ghanchi, Faruque
Rennie, Christina
Santiago, Cynthia
Napier, Jackie
Yang, Yit
author_sort Pearce, Ian
collection PubMed
description OBJECTIVES: This paper describes recommendations from a panel of UK retina experts on aflibercept in diabetic macular oedema (DMO). METHODS: A roundtable meeting was held in London, UK in March 2018. The meeting was sponsored by Bayer. RESULTS: Recommendations are based on clinical experience and level 1 evidence. Clinical experience supports the evidence base, reinforcing that aflibercept should be initiated with intensive proactive dosing at 2 mg every 4 weeks. Most panel members use six initial 4-weekly doses as in Protocol T, rather than five initial monthly doses as recommended in the Summary of product characteristics (SmPC). After intensive proactive dosing, patients with a good response (meet Protocol T ‘improvement’ criteria ≥5-letter improvement in visual acuity [VA] and/or ≥10% improvement in central subfield thickness [CST] from baseline) but who are not yet stable should continue with 4-weekly aflibercept until stability is reached. Patients with a good response and stability should initiate monitor-and-extend (not in line with SmPC). Those with a sub-optimal response (meet ‘improvement’ criteria but with additional concerns e.g. fluid worsening on macular volume map) should continue with 4-weekly aflibercept but additional treatments should be considered (aflibercept is not licensed for combination treatment). For patients with no response (no change, or meeting Protocol T ‘worsening’ criteria [≥5-letter decrease in VA and/or ≥ 10% increase in CST] from baseline), switching to a non-anti-vascular endothelial growth factor treatment should be considered. CONCLUSIONS: Clinical experience reinforces that, when using aflibercept in DMO, the licensed posology or Protocol T regimens achieve the best outcomes.
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spelling pubmed-71825512020-04-29 Translating evidence into practice: recommendations by a UK expert panel on the use of aflibercept in diabetic macular oedema Pearce, Ian Bailey, Clare Fletcher, Emily Ghanchi, Faruque Rennie, Christina Santiago, Cynthia Napier, Jackie Yang, Yit Eye (Lond) Article OBJECTIVES: This paper describes recommendations from a panel of UK retina experts on aflibercept in diabetic macular oedema (DMO). METHODS: A roundtable meeting was held in London, UK in March 2018. The meeting was sponsored by Bayer. RESULTS: Recommendations are based on clinical experience and level 1 evidence. Clinical experience supports the evidence base, reinforcing that aflibercept should be initiated with intensive proactive dosing at 2 mg every 4 weeks. Most panel members use six initial 4-weekly doses as in Protocol T, rather than five initial monthly doses as recommended in the Summary of product characteristics (SmPC). After intensive proactive dosing, patients with a good response (meet Protocol T ‘improvement’ criteria ≥5-letter improvement in visual acuity [VA] and/or ≥10% improvement in central subfield thickness [CST] from baseline) but who are not yet stable should continue with 4-weekly aflibercept until stability is reached. Patients with a good response and stability should initiate monitor-and-extend (not in line with SmPC). Those with a sub-optimal response (meet ‘improvement’ criteria but with additional concerns e.g. fluid worsening on macular volume map) should continue with 4-weekly aflibercept but additional treatments should be considered (aflibercept is not licensed for combination treatment). For patients with no response (no change, or meeting Protocol T ‘worsening’ criteria [≥5-letter decrease in VA and/or ≥ 10% increase in CST] from baseline), switching to a non-anti-vascular endothelial growth factor treatment should be considered. CONCLUSIONS: Clinical experience reinforces that, when using aflibercept in DMO, the licensed posology or Protocol T regimens achieve the best outcomes. Nature Publishing Group UK 2019-10-16 2020-05 /pmc/articles/PMC7182551/ /pubmed/31619777 http://dx.doi.org/10.1038/s41433-019-0615-8 Text en © The Author(s) 2019 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Article
Pearce, Ian
Bailey, Clare
Fletcher, Emily
Ghanchi, Faruque
Rennie, Christina
Santiago, Cynthia
Napier, Jackie
Yang, Yit
Translating evidence into practice: recommendations by a UK expert panel on the use of aflibercept in diabetic macular oedema
title Translating evidence into practice: recommendations by a UK expert panel on the use of aflibercept in diabetic macular oedema
title_full Translating evidence into practice: recommendations by a UK expert panel on the use of aflibercept in diabetic macular oedema
title_fullStr Translating evidence into practice: recommendations by a UK expert panel on the use of aflibercept in diabetic macular oedema
title_full_unstemmed Translating evidence into practice: recommendations by a UK expert panel on the use of aflibercept in diabetic macular oedema
title_short Translating evidence into practice: recommendations by a UK expert panel on the use of aflibercept in diabetic macular oedema
title_sort translating evidence into practice: recommendations by a uk expert panel on the use of aflibercept in diabetic macular oedema
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182551/
https://www.ncbi.nlm.nih.gov/pubmed/31619777
http://dx.doi.org/10.1038/s41433-019-0615-8
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