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. 2023 Apr 4;9(1):23.
doi: 10.1186/s40942-023-00453-0.

Predictive factors for treatment outcomes with intravitreal anti-vascular endothelial growth factor injections in diabetic macular edema in clinical practice

Rajya L Gurung  1 , Liesel M FitzGerald  2 , Ebony Liu  3 , Bennet J McComish  2 , Georgia Kaidonis  3 , Bronwyn Ridge  3 , Alex W Hewitt  2   4 , Brendan J Vote  4 , Nitin Verma  4 , Jamie E Craig  3 , Kathryn P Burdon  2
Affiliations

Predictive factors for treatment outcomes with intravitreal anti-vascular endothelial growth factor injections in diabetic macular edema in clinical practice

Rajya L Gurung et al. Int J Retina Vitreous. .

Abstract

Background: Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections are the standard of care for diabetic macular edema (DME), a common complication of diabetes. This study aimed to identify factors influencing DME intravitreal anti-VEGF treatment outcomes in real-world practice.

Methods: This was a multi-center retrospective observational study using medical chart review of participants receiving anti-VEGF injections for DME (N = 248). Demographic and clinical variables were assessed for association with best corrected visual acuity (BCVA) and central macular thickness (CMT) outcomes using regression models.

Results: There was a significant improvement in BCVA (p < 0.001) and CMT (p < 0.001) after 12 months of treatment, although 21% of participants had decreased BCVA, and 41% had a < 10% CMT reduction at 12 months. Higher baseline BCVA (p = 0.022, OR=-0.024, 95% CI=-0.046,-0.004) and longer duration of diabetic retinopathy (p = 0.048, OR=-0.064, 95% CI=-0.129,-0.001) were negative predictors for BCVA response, whereas Aflibercept treatment (p = 0.017, OR = 1.107, 95% CI = 0.220,2.051) compared with other drugs and a positive "early functional response" (p < 0.001, OR=-1.393, 95% CI=-1.946,-0.857) were positive predictors. A higher baseline CMT (p < 0.001, OR = 0.019, 95% CI = 0.012,0.0261) and an "early anatomical response", (p < 0.001, OR=-1.677, 95% CI=-2.456, -0.943) were predictors for greater reduction in CMT. Overall, the variables could predict only 23% of BCVA and 52% of CMT response.

Conclusions: The study shows a significant proportion of DME patients do not respond to anti-VEGF therapy and identifies several clinical predictors for treatment outcomes.

Trial registration: The study was approved through the Human Research Ethics Committee, University of Tasmania (approval number H0012902), and the Southern Adelaide Clinical Human Research Ethics Committee (approval number 86 - 067).

Keywords: Anti-VEGF; Best-corrected visual acuity; Central macular thickness; Diabetic macular edema.

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Conflict of interest statement

None declared.

Figures

Fig. 1
Fig. 1
Mean outcome measures at baseline, 4 months and 12 months
Fig. 2
Fig. 2
Predictors of response (Multivariable regression) at the end of 12 months: 2a Functional response; 2b Anatomical response
See this image and copyright information in PMC

References

    1. Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35(3):556–64. doi: 10.2337/dc11-1909. - DOI - PMC - PubMed
    1. Thomas R, Halim S, Gurudas S, Sivaprasad S, Owens D. IDF Diabetes Atlas: A review of studies utilising retinal photography on the global prevalence of diabetes related retinopathy between 2015 and 2018. Diabetes Res Clin Pract. 2019:107840. - PubMed
    1. Brown DM, Nguyen QD, Marcus DM, Boyer DS, Patel S, Feiner L et al. Long-term outcomes of ranibizumab therapy for diabetic macular edema: the 36-month results from two phase III trials: RISE and RIDE.Ophthalmology. 2013;120(10). - PubMed
    1. Cai S, Bressler NM. Aflibercept, bevacizumab or ranibizumab for diabetic macular oedema: recent clinically relevant findings from DRCR. Net protocol T. Curr Opin Ophthalmol. 2017;28(6):636–43. doi: 10.1097/ICU.0000000000000424. - DOI - PubMed
    1. Bressler SB, Glassman AR, Almukhtar T, Bressler NM, Ferris FL, Googe JM, Jr, et al. Five-year outcomes of ranibizumab with prompt or deferred laser versus laser or triamcinolone plus deferred ranibizumab for diabetic macular edema. Am J Ophthalmol. 2016;164:57–68. doi: 10.1016/j.ajo.2015.12.025. - DOI - PMC - PubMed

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