Cargando…
One-year outcomes of Aflibercept for refractory diabetic macular edema in Bevacizumab nonresponders
PURPOSE: A sub-population of patients with diabetic macular edema (DME) responds less effectively to off-label use of Bevacizumab. Approval of Aflibercept for DME has offered Bevacizumab nonresponders an alternative therapeutic option. Herein, we investigate the anatomical and functional changes ass...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer - Medknow
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7933844/ https://www.ncbi.nlm.nih.gov/pubmed/33463593 http://dx.doi.org/10.4103/ijo.IJO_459_20 |
_version_ | 1783660701214048256 |
---|---|
author | Salimi, Ali Vila, Natalia Modabber, Milad Kapusta, Michael |
author_facet | Salimi, Ali Vila, Natalia Modabber, Milad Kapusta, Michael |
author_sort | Salimi, Ali |
collection | PubMed |
description | PURPOSE: A sub-population of patients with diabetic macular edema (DME) responds less effectively to off-label use of Bevacizumab. Approval of Aflibercept for DME has offered Bevacizumab nonresponders an alternative therapeutic option. Herein, we investigate the anatomical and functional changes associated with Aflibercept treatment in Bevacizumab nonresponders with chronic DME in a Canadian setting. METHODS: A retrospective study of eyes with persistent DME that were switched to Aflibercept due to nonresponse following ≥6 consecutive monthly Bevacizumab injections was performed. Anatomical and functional changes and the predictors of response were assessed using patients' characteristics prior to receiving their first (baseline) and seventh consecutive Aflibercept injections (follow-up). RESULTS: Twenty-four eyes were included, with a mean age of 63.9 ± 10.7 years, an average of 16.8 ± 8.5 Bevacizumab injections prior to switching to Aflibercept, and mean follow-up duration of 11.8 ± 1.7 months following switching to Aflibercept. Best-corrected visual acuity (BCVA) improved significantly from 0.49 ± 0.13 to 0.41 ± 0.11 logMAR (P < 0.001) and central subfield thickness (CST) decreased by 119.4 μm from 409.4 ± 85.8 μm to 290.0 ± 64.5 μm (P < 0.001), with 50% of eyes showing complete anatomical response. Worse BCVA and higher CST at baseline predicted greater vision improvements (P = 0.001 and P = 0.035, respectively) while a larger decrease in CST was associated with greater baseline CST (P = 0.001) and better glycemic control (P = 0.039). CONCLUSION: Our data from a real-world clinical setting highlight the efficacy of Aflibercept as an alternative therapeutic option for DME recalcitrant to Bevacizumab, with potential additional benefit to those with worse vision, greater CST, and better glycemic control at baseline. |
format | Online Article Text |
id | pubmed-7933844 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Wolters Kluwer - Medknow |
record_format | MEDLINE/PubMed |
spelling | pubmed-79338442021-03-08 One-year outcomes of Aflibercept for refractory diabetic macular edema in Bevacizumab nonresponders Salimi, Ali Vila, Natalia Modabber, Milad Kapusta, Michael Indian J Ophthalmol Special Focus on Anti-VEGF, Original Article PURPOSE: A sub-population of patients with diabetic macular edema (DME) responds less effectively to off-label use of Bevacizumab. Approval of Aflibercept for DME has offered Bevacizumab nonresponders an alternative therapeutic option. Herein, we investigate the anatomical and functional changes associated with Aflibercept treatment in Bevacizumab nonresponders with chronic DME in a Canadian setting. METHODS: A retrospective study of eyes with persistent DME that were switched to Aflibercept due to nonresponse following ≥6 consecutive monthly Bevacizumab injections was performed. Anatomical and functional changes and the predictors of response were assessed using patients' characteristics prior to receiving their first (baseline) and seventh consecutive Aflibercept injections (follow-up). RESULTS: Twenty-four eyes were included, with a mean age of 63.9 ± 10.7 years, an average of 16.8 ± 8.5 Bevacizumab injections prior to switching to Aflibercept, and mean follow-up duration of 11.8 ± 1.7 months following switching to Aflibercept. Best-corrected visual acuity (BCVA) improved significantly from 0.49 ± 0.13 to 0.41 ± 0.11 logMAR (P < 0.001) and central subfield thickness (CST) decreased by 119.4 μm from 409.4 ± 85.8 μm to 290.0 ± 64.5 μm (P < 0.001), with 50% of eyes showing complete anatomical response. Worse BCVA and higher CST at baseline predicted greater vision improvements (P = 0.001 and P = 0.035, respectively) while a larger decrease in CST was associated with greater baseline CST (P = 0.001) and better glycemic control (P = 0.039). CONCLUSION: Our data from a real-world clinical setting highlight the efficacy of Aflibercept as an alternative therapeutic option for DME recalcitrant to Bevacizumab, with potential additional benefit to those with worse vision, greater CST, and better glycemic control at baseline. Wolters Kluwer - Medknow 2021-02 2021-01-18 /pmc/articles/PMC7933844/ /pubmed/33463593 http://dx.doi.org/10.4103/ijo.IJO_459_20 Text en Copyright: © 2021 Indian Journal of Ophthalmology http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. |
spellingShingle | Special Focus on Anti-VEGF, Original Article Salimi, Ali Vila, Natalia Modabber, Milad Kapusta, Michael One-year outcomes of Aflibercept for refractory diabetic macular edema in Bevacizumab nonresponders |
title | One-year outcomes of Aflibercept for refractory diabetic macular edema in Bevacizumab nonresponders |
title_full | One-year outcomes of Aflibercept for refractory diabetic macular edema in Bevacizumab nonresponders |
title_fullStr | One-year outcomes of Aflibercept for refractory diabetic macular edema in Bevacizumab nonresponders |
title_full_unstemmed | One-year outcomes of Aflibercept for refractory diabetic macular edema in Bevacizumab nonresponders |
title_short | One-year outcomes of Aflibercept for refractory diabetic macular edema in Bevacizumab nonresponders |
title_sort | one-year outcomes of aflibercept for refractory diabetic macular edema in bevacizumab nonresponders |
topic | Special Focus on Anti-VEGF, Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7933844/ https://www.ncbi.nlm.nih.gov/pubmed/33463593 http://dx.doi.org/10.4103/ijo.IJO_459_20 |
work_keys_str_mv | AT salimiali oneyearoutcomesofafliberceptforrefractorydiabeticmacularedemainbevacizumabnonresponders AT vilanatalia oneyearoutcomesofafliberceptforrefractorydiabeticmacularedemainbevacizumabnonresponders AT modabbermilad oneyearoutcomesofafliberceptforrefractorydiabeticmacularedemainbevacizumabnonresponders AT kapustamichael oneyearoutcomesofafliberceptforrefractorydiabeticmacularedemainbevacizumabnonresponders |