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Review
. 2022 Oct;22(10):1275-1291.
doi: 10.1080/14712598.2022.2100694. Epub 2022 Jul 17.

Efficacy and safety of intravitreal anti-VEGF therapy in diabetic retinopathy: what we have learned and what should we learn further?

Gunay Uludag  1 , Muhammad Hassan  1 , Wataru Matsumiya  1   2 , Brandon Huy Pham  1   3 , Sophaktra Chea  1 , Ngoc Trong Tuong Than  1 , Hien Luong Doan  1 , Amir Akhavanrezayat  1 , Muhammad Sohail Halim  1   4 , Diana V Do  1 , Quan Dong Nguyen  1
Affiliations
Review

Efficacy and safety of intravitreal anti-VEGF therapy in diabetic retinopathy: what we have learned and what should we learn further?

Gunay Uludag et al. Expert Opin Biol Ther. 2022 Oct.

Abstract

Introduction: Diabetic retinopathy (DR) is one of the most frequent microvascular complications of diabetes that can lead to blindness. Laser treatment has been the gold standard treatment for diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) for many years. Recently, the role of vascular endothelial growth factor (VEGF) has been established in the pathogenesis of DR, and the use of intravitreal anti-VEGF therapy has gained popularity for the management of DR.

Areas covered: This review includes a brief overview of the efficacy and safety of currently available (bevacizumab, ranibizumab, and aflibercept) and potential future (brolucizumab, faricimab, and KSI-301) anti-VEGF agents in patients with DR based mainly on publicly available data from phase 1, 2 and 3 clinical trials.

Expert opinion: Clinical trials investigating the efficacy of intravitreal bevacizumab, ranibizumab, and aflibercept injections demonstrated favorable functional and anatomical outcomes in patients with DME. Moreover, the use of these anti-VEGF agents showed a significant improvement in the severity of DR. Recent clinical research for future anti-VEGF molecules aims to provide higher target-protein binding affinity and prolonged therapeutic effect. Brolucizumab, faricimab, and KSI-301 are three novel anti-VEGF agents that demonstrate promising data for the management of DME and potentially DR.

Keywords: Aflibercept; anti-vascular endothelial growth factor; bevacizumab; diabetic macular edema; diabetic retinopathy; ranibizumab; vascular endothelial growth factor.

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Conflict of interest statement

QD Nguyen serves on the scientific advisory boards for Bausch and Lomb, Bayer, Genentech/Roche, Regeneron, Novartis and Santen. QD Nguyen has also chaired the steering committee for the RISE and RIDE studies and was on the steering committee for the VISTA Study, as well as other studies sponsored by Genentech and Regeneron. DV Do serves on the scientific advisory boards for Allergan, Kodiak, Genentech and Regeneron. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Figures

Figure 1.
Figure 1.
The structure of a full-length IgG1 bevacizumab antibody. Yellow stars represent glycosylation sites.
Figure 2.
Figure 2.
The structure of a ranibizumab IgG1 antibody fragment composed of the affinity maturated Fab of bevacizumab.
Figure 3.
Figure 3.
The structure of aflibercept composed of domains from VEGFR1 and 2 fused to an IgG1 Fc-region.
See this image and copyright information in PMC

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