December 05, 2013
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Treatment protocols for VEGF inhibitors in DME await results of major trials

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VIENNA — VEGF inhibitors are now first-line therapy for center-involved diabetic macular edema with reduced vision, and treatment protocols are rapidly evolving. However, data regarding many aspects of initiation, cessation and restarting of therapy remain unknown, a speaker said at the Advanced Retinal Therapy meeting here.

The Diabetic Retinopathy Clinical Research Network (DRCR.net) protocol trial demonstrated that Lucentis (ranibizumab, Novartis/Genentech) with deferred or prompt focal/grid laser resulted in superior visual acuity outcomes compared with laser alone, Lloyd A. Aiello, MD, said. Over 3 years, more than half of the eyes did not require any focal/grid laser.

Eylea (aflibercept, Regeneron/Bayer HealthCare) was also tested more recently in association with laser and demonstrated similarly better results compared with laser alone.

DRCR.net Protocol T is currently comparing aflibercept, ranibizumab and Avastin (bevacizumab, Roche/Genentech). Results are expected within the next 15 months.

Consensus should be reached on treatment protocols following the results of these studies. Meanwhile, Aiello suggested a simplified re-treatment and follow-up algorithm, beginning with an initial series of injections 1 month apart and assessment 1 month later.

“Determine if DME is improving. If it is, re-inject and see the patient again in 1 month,” he said. “If the edema is no longer improving, then you can skip the injection and ask the patient to return for re-evaluation in 1 month. Determine at that time if the edema is worsening or recurring. If it is, re-inject and restart with monthly re-evaluation once again. If it is not worsening or recurring, double the follow-up interval up to 4 months and then re-evaluate for worsening or recurring.”

Disclosure: Aiello is a consultant to Genentech, Novartis and Regeneron.