DRCR.net retinal treatment results take center stage in 2015
Studies of the efficacy of anti-vascular endothelial growth factor (VEGF), gene therapies, and slow-release drug delivery systems took center stage among treatments for retinal disorders in 2015. In addition to studies already under way, others are about to begin.
Reviewed by Julia A. Haller, MD, Mary Elizabeth Hartnett, MD, and Carl Regillo, MD
Studies of the efficacy of anti-vascular endothelial growth factor (VEGF), gene therapies, and slow-release drug delivery systems took center stage among treatments for retinal disorders in 2015. In addition to studies already under way, others are about to begin.
DRCR.net Protocols S and T
The results of the Diabetic Retinopathy Clinical Research Network (DRCR.net) Protocols S and T studies were the biggest news of the year for physicians looking for information about retinal therapy along with other clinical studies of the effects of anti-VEGF drugs.
There has been a huge shift in treating diabetic retinopathy to more pharmacologic approaches as evidenced by these two important studies, said Julia A. Haller, MD, ophthalmologist-in-chief, Wills Eye Hospital, and professor and chairperson, Department of Ophthalmology, Jefferson Medical College, Philadelphia.
In February 2015, the DRCR.net published the results of Protocol T, a 1-year comparison of the VEGF drugs ranibizumab (Lucentis, Genentech), aflibercept (Eylea, Regeneron), and bevacizumab (Avastin, Genentech) for treating diabetic macular edema.
“In the past, no trials have shown significant differences in efficacy between the anti-VEGF drugs,” Carl Regillo, MD, commented. “However, Protocol T showed that in patients with more decreased visual acuity or more severe edema, aflibercept seemed to work the best of the three drugs, i.e., a bit better than ranibizumab, which in turn was a bit better than bevacizumab, especially regarding the effectiveness in decreasing the edema.”
More specifically, Mary Elizabeth Hartnett, MD, added that the study found patients with diabetic macular edema and a visual acuity of 20/50 or worse fared better with aflibercept treatment compared with the other drugs by visual acuity, fewer lasers, and fewer injections. Still, additional research is needed for long-term effects and in terms of safety, particularly from systemic effects related to reduced systemic VEGF levels.
Generally, studies report data that are supportive of the use of anti-VEGF agents for diabetic macular edema even as a first line of therapy, which is a paradigm shift from older studies in which laser was done. Nonetheless, only about 40% of patients with diabetic macular edema are helped by anti-VEGF, so other therapies are needed. Both dexamethasone intravitreal implant (Ozurdex, Allergan) and fluocinolone acetonide intravitreal implant, (Iluvien, Alimera Sciences) have shown promising results for diabetic macular edema.
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