Long term outcomes following anti-VEGF therapy for diabetic macular edema

ABSTRACT

Introduction

Anti-VEGF agents have been demonstrated to be more effective than sham or laser in treating center-involving diabetic macular edema (DME) in short-term pivotal trials. The literature regarding long-term outcomes (5 years or more) of anti-VEGF treatments in DME is limited.

Areas covered

A literature search was conducted using the PubMed and Cochrane Library databases. Key words included ‘diabetic macular edema,’ ‘diabetic retinopathy,’ ‘vascular endothelial growth factor,’ ‘anti-VEGF,’ ‘long*,’ and ‘five-year.’ 21 articles were included in the final review that examined the 5-year visual and anatomic outcomes of anti-VEGF treatments in DME. Combined analysis of the mean 5-year change in visual acuity and central retinal thickness was conducted.

Expert opinion

Anti-VEGF agents provide significant vision and anatomic improvements to patients with DME through at least 5 years of treatment. Given their minimal adverse effect profile, superior impact on visual and anatomic outcomes, and likely cost benefit, anti-VEGF agents should be initiated as early as possible in individuals with clinically significant DME causing vision loss. Further work is required to identify early indicators of poor treatment response and to develop longer-acting anti-VEGF treatments.

KEYWORDS:

• Anti-VEGF
• anti-vascular endothelial growth factor
• DME
• diabetic macular edema
• DR
• diabetic retinopathy
• five-year
• long-term

Article highlights

• Among 14 studies reporting mean 5-year change in visual acuity (VA) in patients with DME treated with anti-VEGF agents, the combined mean 5-year change in VA was +4.1 ETDRS letters

• Among 11 studies reporting mean 5-year change in central retinal thickness (CRT) in patients with DME treated with anti-VEGF agents, the combined mean 5-year change in CRT was −132 μm

• Patients treated in real-world studies gained significantly fewer letters than those treated in clinical trials, but still experienced a statistically significant VA gain over 5 years

• Most patients experienced improvements in their ETDRS Diabetic Retinopathy Severity Score relative to baseline which were maintained even on PRN regimens

• Patients were able to maintain their VA and CRT improvements over 5 years despite annual decreases in mean injection and visit numbers

• Patients treated with anti-VEGF agents rarely experienced adverse effects, with vitreous hemorrhage being the most reported

• Future research should focus on the development of longer-acting anti-VEGF agents or delivery methods, as well as on the identification of biomarkers for poor treatment response

Declaration of interest

RP Singh reports personal fees from Genentech/Roche, Alcon/Novartis, Zeiss, Bausch + Lomb, Regeneron Pharmaceuticals, Inc., Gyroscope and Asceplix and grants from Apellis and Graybug. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

A reviewer on this manuscript has disclosed that they work with Janssen R&D LLC. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.