Do new drugs for diabetic macular edema offer a safer option?

ABSTRACT

Introduction

The last decade has witnessed important advances in retinal drug discovery, administered intravitreally, allowing high intraocular concentration and low systemic passage. However, local and systemic adverse events have been described and should be discussed before proposing treatment. In diabetes mellitus specifically, the choice of molecule and treatment regimen should limit the therapeutic burden, avoiding the need for frequent ophthalmological appointments, in patients receiving multi-disciplinary care.

Areas covered

We aim to review and discuss the risk/benefit ratio of the main intravitreal therapies currently proposed for diabetic macular edema (DME), and how these treatments could be tailored to each individual patient.

Expert opinion

Anti-VEGF injections and steroid implants are currently the two therapeutic options proposed in cases of DME. New molecules in these two classes have recently been approved and are currently being studied under phase IV observations to establish their efficacy and tolerance. The preferred therapeutic option is determined based on the ocular condition and the patient profile. As new treatments are developed, new adverse events will also enter into consideration, and retinal physicians must therefore be able to call on a range of therapeutic options and question the risk/benefit ratio of each of them before proposing a treatment.

KEYWORDS:

• Adverse events
• anti-vascular endothelial growth factor
• diabetic macular edema
• intravitreal injection
• retina
• risk/benefit ratio
• steroids

Article highlights

• Diabetic macular edema (DME) represents a hierarchical therapeutic challenge: the first step is to effectively treat the edema, the second step is to limit ocular and systemic adverse events, and the third step is to reduce the treatment burden for diabetic patients who are also followed for other conditions.

• Anti-VEGF injections and steroid implants are currently the two therapeutic options proposed in cases of DME. Their efficacy and safety were widely confirmed in randomized controlled trials observational studies.

• New molecules in these two classes have recently been approved and are currently being studied in observational studies to confirm in large population their efficacy and safety profiles.

• Patient selection and discussion about the risk/benefit ratio are the two key points to raise before proposing a treatment in DME.

Declaration of interests

T Mathis is a consultant for AbbVie, Bayer, GSK Horus and Novartis. L Kodjikian is consultant for AbbVie-Allergan, Bayer, Alimera-Horus, Roche, Thea and Novartis.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contribution statement

Conceptualization: T Mathis and L Kodjikian; Writing – review and editing: T Mathis and L Kodjikian. All authors have read and agreed to the published version of the manuscript.

Additional information

Funding

This paper was not funded.