May 19, 2020
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Baseline diabetic retinopathy severity affects improvement with ranibizumab

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Eyes with moderately severe to severe baseline diabetic retinopathy without prior panretinal photocoagulation experienced more rapid improvements from ranibizumab treatment compared with eyes with more mild or severe diabetic retinopathy, according to a presenter at the virtual Association for Research in Vision and Ophthalmology meeting.

“Eyes with moderately severe to severe NPDR at baseline achieved a two or more step improvement in diabetic retinopathy over time. These findings support treating eyes with moderately severe to severe NPDR before they progress to PDR,” Mitchell Goff, MD, said.

Goff and colleagues conducted an ad hoc analysis of the RISE and RIDE phase 3 trials to evaluate the relationship between baseline diabetic retinopathy severity and time to diabetic retinopathy improvement. The RISE and RIDE trials evaluated monthly 0.3 mg and 0.5 mg ranibizumab injections for patients with diabetic retinopathy and vision loss due to diabetic macular edema.

A total of 443 eyes were evaluated, and the researchers assessed the time to a two or more step improvement in the Early Treatment Diabetic Retinopathy Study Diabetic Retinopathy Severity Scale from baseline and the proportion of patients with a two or more step improvement at months 3 or 6.

The researchers found eyes with moderately severe to severe nonproliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR) without prior panretinal photocoagulation (PRP) at baseline achieved the greatest two or more step diabetic retinopathy improvement at month 3. Additionally, eyes with moderately severe to severe NPDR at baseline achieved the greatest two or more step improvement at month 6.

“The median time to clinically meaningful improvement for eyes with PDR without prior PRP to moderately severe to severe NPDR at baseline was 4.5 months and 6 months, respectively,” Goff said.

Few eyes with PDR and a history of PRP experienced a two or more step diabetic retinopathy improvement in the studies. If the eyes did experience a two or more step improvement, the time was significantly longer compared with eyes with no prior PRP, he said.

“It’s important to recognize a floor effect influences the improvement of diabetic retinopathy severity in eyes with mild to moderate disease or proliferative disease with prior PRP. Patients with mild to moderate NPDR at baseline have little room for improvement on the diabetic retinopathy severity scale,” Goff said.

In patients with prior PRP, the presence of PRP scars automatically results in a severity score of 60, making it impossible for these patients to improve to an NPDR level, he said. – by Robert Linnehan

Reference:

Goff M. Baseline diabetic retinopathy severity affects time to clinically meaningful improvements in diabetic retinopathy during ranibizumab treatment. Presented at: Association for Research in Vision and Ophthalmology annual meeting; May 6, 2020 (virtual meeting).

Disclosure: Goff reports he is a consultant with Genentech, Novartis and Regeneron.