Findings from studies investigating intravitreal corticosteroids for treatment of diabetic macular edema (DME) provide information about their efficacy and safety, including some understanding of how they compare with anti-VEGF therapy.
However, forthcoming results from the Diabetic Retinopathy Clinical Research Network (DRCR.net) Protocol U are anticipated to help retina specialists better define how to incorporate corticosteroids into the treatment algorithm for DME, said Rishi P. Singh, MD. Protocol U is a short-term study that randomized eyes with central-involved DME persisting after anti-VEGF therapy to continue anti-VEGF therapy alone or with an intravitreal corticosteroid implant,
“With anti-VEGF therapy, we have excellent treatment options for DME,” said Dr. Singh, associate professor of ophthalmology, Case Western Reserve University, Cleveland, and president, Retina World Congress. “We know, however, from clinical trials of anti-VEGF therapy that persistent DME is a common finding. Furthermore, anti-VEGF therapy is being dosed less frequently in clinical practice compared with clinical trials, and the difference in treatment limits visual outcomes.”
Based on available evidence for corticosteroid clinical trials, Dr. Singh made five observations about their efficacy and safety for treatment of DME:
- Corticosteroids, unlike anti-VEGF therapy, address the inflammatory component of DME pathophysiology;
- Corticosteroid treatment can provide similar cumulative improvement in visual acuity but with a lower injection burden compared with anti-VEGF therapy;
- Corticosteroids can prevent progression to proliferative diabetic retinopathy (PDR);
- Conversion to corticosteroid treatment has resulted in good outcomes in patients with DME recalcitrant to anti-VEGF therapy;
- The IOP responses associated with corticosteroid treatment are predictable and manageable.