Reviewed by Scott M. Whitcup, MD
Los Angeles—Patients with diabetic macular edema (DME) are looking for prompt, consistent, and long-lasting improvement in vision.
A new analysis of an old study suggests that early response to agents that block vascular endothelial growth factor can predict longer-term improvement in visual acuity in patients with DME.
“The key finding is that early change in visual acuity, after three injections of ranibizumab, is highly predictive of how patients will do over the remaining three year study and how consistent their vision response will be,” said Scott M. Whitcup, MD, clinical faculty member of the Jules Stein Eye Institute of the David Geffen School of Medicine at the University of California, Los Angeles. “The clinical implication is that patients who don’t respond well after three anti-VEGF injections are generally the patients who will not do well over the longer term and the patients where additional therapy or a change in therapy may be warranted.”
Dr. Whitcup presented a post hoc analysis of Diabetic Retinopathy Clinical Research Network (DRCRnet) Protocol I data. He was chief scientific officer at Allergan during the DRCRnet Protocol I study that compared ranibizumab plus prompt or deferred laser photocoagulation or triamcinolone plus prompt laser for DME. He is currently founder and chief executive officer of Akrivista and Whitecap Biosciences.
The original analysis of DRCRnet Protocol I found that intravitreal ranibizumab plus laser photocoagulation either within a week of the initial injection or later during treatment provided better anatomic and functional outcomes than laser alone. The original study did not attempt to tease out factors that might predict success or failure of treatment. Until this post hoc analysis, physicians often continued treating with anti-VEGF without any guide as the likelihood of long-term improvement in vision.