When to Perform a Treatment Switch in Diabetic Macular Edema in Patients with Inadequate Response to Anti-VEGF
Main Article Content
Abstract
Diabetic macular edema (DME) is the most common cause of vision loss in diabetic patients. Multiple therapeutic options are currently available for these patients, including laser photocoagulation; intravitreal injections of anti-vascular endothelial growth factor (VEGF) drugs or steroids; or pars plana vitrectomy for tractional DME. The initial treatment for DME is well-defined and widely accepted, with anti-VEGF as first-line option. Nevertheless, between 30 and 40% of patients show partial response or no response whatsoever. There is no consensus on the number of injections needed in order to classify a patient as a non-responder or sub-optimal responder, nor on the definition of the latter. In this study, these concepts are analysed as well as the different therapeutic alternatives at hand, with special interest on the switch between different anti-VEGF and/or steroids. These analyses are performed from an anatomical and functional point of view as well as from an economic, cost-effectiveness perspective. Recent evidence suggests that an early switch to dexamethasone implant in eyes that did not respond adequately to anti-VEGF therapy after 3 injections provides better functional outcomes while alleviating the heavy economic burden of this disease.
Keywords:
macular edema, diabetic retinopathy, dexamethasone, anti-VEGF
Article Details
How to Cite
RUIZ-MEDRANO, Jorge; GONZALEZ-BUENDIA, Lucia; RUIZ-MORENO, José M..
When to Perform a Treatment Switch in Diabetic Macular Edema in Patients with Inadequate Response to Anti-VEGF.
Medical Research Archives, [S.l.], v. 10, n. 5, june 2022.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/2741>. Date accessed: 25 apr. 2024.
doi: https://doi.org/10.18103/mra.v10i5.2741.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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3. Liu Y, Cheng J, Gao Y, Qin L, Min X, Zhang M. Efficacy of switching therapy to aflibercept for patients with persistent diabetic macular edema: a systematic review and meta-analysis. Ann Transl Medicine. 2020;8(6):382. doi:10.21037/atm.2020.02.04
4. Kocur I, Resnikoff S. Visual impairment and blindness in Europe and their prevention. Brit J Ophthalmol. 2002;86(7):716. doi:10.1136/bjo.86.7.716
5. Furino C, Boscia F, Reibaldi M, Alessio G. Intravitreal Therapy for Diabetic Macular Edema: An Update. J Ophthalmol. 2021;2021:1-23. doi:10.1155/2021/6654168
6. Photocoagulation for Diabetic Macular Edema: Early Treatment Diabetic Retinopathy Study Report Number 1 Early Treatment Diabetic Retinopathy Study Research Group. Arch Ophthalmol-chic. 1985;103(12):1796-1806. doi:10.1001/archopht.1985.01050120030015
7. Moisseiev E, Loewenstein A. Diabetic Macular Edema: Emerging Strategies and Treatment Algorithms. Dev Ophthalmol. 2017;60:165-174. doi:10.1159/000459706
8. Group ETDRSR. Treatment Techniques and Clinical Guidelines for Photocoagulation of Diabetic Macular Edema Early Treatment Diabetic Retinopathy Study Report Number 2. Ophthalmology. 1987;94(7):761-774. doi:10.1016/s0161-6420(87)33527-4
9. Schmidt-Erfurth U, Garcia-Arumi J, Bandello F, et al. Guidelines for the Management of Diabetic Macular Edema by the European Society of Retina Specialists (EURETINA). Ophthalmologica. 2017;237(4):185-222. doi:10.1159/000458539
10. Martidis A, Duker JS, Greenberg PB, et al. Intravitreal triamcinolone for refractory diabetic macular edema. Ophthalmology. 2002;109(5):920-927. doi:10.1016/s0161-6420(02)00975-2
11. Gillies MC, Sutter FKP, Simpson JM, Larsson J, Ali H, Zhu M. Intravitreal Triamcinolone for Refractory Diabetic Macular Edema Two-Year Results of a Double-Masked, Placebo-Controlled, Randomized Clinical Trial. Ophthalmology. 2006;113(9):1533-1538. doi:10.1016/j.ophtha.2006.02.065
12. Network TDRCR, Elman MJ, Aiello LP, et al. Randomized Trial Evaluating Ranibizumab Plus Prompt or Deferred Laser or Triamcinolone Plus Prompt Laser for Diabetic Macular Edema. Ophthalmology. 2010;117(6):1064-1077.e35. doi:10.1016/j.ophtha.2010.02.031
13. Danis RP, Sadda S, Li XY, Cui H, Hashad Y, Whitcup SM. Anatomical effects of dexamethasone intravitreal implant in diabetic macular oedema: a pooled analysis of 3-year phase III trials. Br J Ophthalmol. 2016;100(6):796-801. doi:10.1136/bjophthalmol-2015-306823
14. Boyer DS, Yoon YH, Belfort R, et al. Three-Year, Randomized, Sham-Controlled Trial of Dexamethasone Intravitreal Implant in Patients with Diabetic Macular Edema. Ophthalmology. 2014;121(10):1904-1914. doi:10.1016/j.ophtha.2014.04.024
15. Campochiaro PA, Hafiz G, Shah SM, et al. Sustained Ocular Delivery of Fluocinolone Acetonide by an Intravitreal Insert. Ophthalmology. 2010;117(7):1393-1399.e3. doi:10.1016/j.ophtha.2009.11.024
16. Abreu-Gonzalez R, Gallego-Pinazo R, Abraldes M, Pinilla I, Lopez-Galvez MI. Management of diabetic macular edema patients in clinical practice in Spain. Eur J Ophthalmol. 2018;29(6):664-672. doi:10.1177/1120672118804079
17. Gillies MC, Lim LL, Campain A, et al. A Randomized Clinical Trial of Intravitreal Bevacizumab versus Intravitreal Dexamethasone for Diabetic Macular Edema The BEVORDEX Study. Ophthalmology. 2014;121(12):2473-2481. doi:10.1016/j.ophtha.2014.07.002
18. Nguyen QD, Shah SM, Khwaja AA, et al. Two-Year Outcomes of the Ranibizumab for Edema of the mAcula in Diabetes (READ-2) Study. Ophthalmology. 2010;117(11):2146-2151. doi:10.1016/j.ophtha.2010.08.016
19. Nguyen QD, Brown DM, Marcus DM, et al. Ranibizumab for Diabetic Macular Edema Results from 2 Phase III Randomized Trials: RISE and RIDE. Ophthalmology. 2012;119(4):789-801. doi:10.1016/j.ophtha.2011.12.039
20. Network DRCR, Elman MJ, Qin H, et al. Intravitreal Ranibizumab for Diabetic Macular Edema with Prompt versus Deferred Laser Treatment Three-Year Randomized Trial Results. Ophthalmology. 2012;119(11):2312-2318. doi:10.1016/j.ophtha.2012.08.022
21. Prünte C, Fajnkuchen F, Mahmood S, et al. Ranibizumab 0.5 mg treat-and-extend regimen for diabetic macular oedema: the RETAIN study. Brit J Ophthalmol. 2016;100(6):787. doi:10.1136/bjophthalmol-2015-307249
22. Freund KB, Korobelnik JF, Devenyi R, et al. TREAT-AND-EXTEND REGIMENS WITH ANTI-VEGF AGENTS IN RETINAL DISEASES. Retin. 2015;35(8):1489-1506. doi:10.1097/iae.0000000000000627
23. Bressler SB, Ayala AR, Bressler NM, et al. Persistent Macular Thickening After Ranibizumab Treatment for Diabetic Macular Edema With Vision Impairment. Jama Ophthalmol. 2016;134(3):1-8. doi:10.1001/jamaophthalmol.2015.5346
24. Gonzalez VH, Campbell J, Holekamp NM, et al. Early and Long-Term Responses to Anti–Vascular Endothelial Growth Factor Therapy in Diabetic Macular Edema: Analysis of Protocol I Data. Am J Ophthalmol. 2016;172:72-79. doi:10.1016/j.ajo.2016.09.012
25. Dugel PU, Campbell JH, Kiss S, et al. ASSOCIATION BETWEEN EARLY ANATOMIC RESPONSE TO ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY AND LONG-TERM OUTCOME IN DIABETIC MACULAR EDEMA. Retin. 2019;39(1):88-97. doi:10.1097/iae.0000000000002110
26. Couturier A, Giocanti-Auregan A, Massin P. Les switchs de traitement dans l’œdème maculaire diabétique : revue de la littérature et algorithme de prise en charge. J Français D’ophtalmologie. 2020;43(8):710-717. doi:10.1016/j.jfo.2019.12.006
27. Martínez AH, Delgado EP, Silva GS, et al. Early versus late switch: How long should we extend the anti-vascular endothelial growth factor therapy in unresponsive diabetic macular edema patients? Eur J Ophthalmol. 2019;30(5):1091-1098. doi:10.1177/1120672119848257
28. Group F the IR, Busch C, Zur D, et al. Shall we stay, or shall we switch? Continued anti-VEGF therapy versus early switch to dexamethasone implant in refractory diabetic macular edema. Acta Diabetol. 2018;55(8):789-796. doi:10.1007/s00592-018-1151-x
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