NEW ORLEANS – The Diabetic Retinopathy Clinical Research Network’s short-term evaluation of combination dexamethasone and ranibizumab compared to ranibizumab alone for persistent central-involved diabetic macular edema (DME) following anti-vascular endothelial growth factor (VEGF) therapy - otherwise known as Protocol U - found there were no differences between the two arms in visual acuity improvements, but a statistically significant difference in central subfield thickness as measured by optical coherence tomography.
Raj Maturi, MD (Indianapolis, Ind.) said there was a higher number of 15+ letter gainers in the combination arm, but that did not reach statistical significance.
At the end of the 24-week study, however, 52% of those in the combined arm (N=65) had a flat retina compared to only 31% in the ranibizumab only arm (N=64).
Of those in the combination arm, 20% needed treatment for elevated intraocular pressure, he said.
At the Modern Retina Facebook Live event after Subspecialty Day, Drs. Charles Wykoff (Houston), Rick Spaide (New York) and Judy Kim (Milwaukee, Wisc.) discussed the findings.
Dr. Spaide said it was “amazing” that adding an additional treatment yielded little additional benefit.
Dr. Wykoff agreed, but said he does not correct people based on visual acuity.
“If they’re not seeing well, the only thing I can do to make them see better (aside from refracting them or cataract surgery) is to thin their retina out,” he said.
Dr. Kim disagreed, however, saying what the data told her was that “I may not need to chase after the fluids as hard as I’m doing now.”
All three experts agreed, however, that this is only short-term data to date, and longer term results may provide more insight.
“We know from RIDE and RISE and VIVID/VISTA that if you don’t dry them out, you can’t get them to where they could have been if you wait,” Dr. Wykoff said.
- Michelle Dalton, ELS