Real-world outcomes of non-responding diabetic macular edema treated with continued anti-VEGF therapy versus early switch to dexamethasone implant: 2-year results

© 2019, Springer-Verlag Italia S.r.l., part of Springer Nature. Aims: To provide 2-year follow-up data on eyes with diabetic macular edema (DME) that were non-responsive after three initial anti-vascular endothelial growth factor (VEGF) injections, comparing functional and anatomical outcomes under...

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Main Authors: Catharina Busch, Samantha Fraser-Bell, Matias Iglicki, Marco Lupidi, Aude Couturier, Voraporn Chaikitmongkol, Ermete Giancipoli, Patricio J. Rodríguez-Valdés, Pierre Henry Gabrielle, Inês Laíns, Ana Rita Santos, Zafer Cebeci, Atchara Amphornphruet, Valentin Degenhardt, Jan Darius Unterlauft, Carlo Cagini, Valérie Mané-Tauty, Giuseppe D’Amico Ricci, Isaac Hindi, Kushal Agrawal, Jay Chhablani, Anat Loewenstein, Dinah Zur, Matus Rehak
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Published: 2020
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spelling th-cmuir.6653943832-676012020-04-02T15:12:04Z Real-world outcomes of non-responding diabetic macular edema treated with continued anti-VEGF therapy versus early switch to dexamethasone implant: 2-year results Catharina Busch Samantha Fraser-Bell Matias Iglicki Marco Lupidi Aude Couturier Voraporn Chaikitmongkol Ermete Giancipoli Patricio J. Rodríguez-Valdés Pierre Henry Gabrielle Inês Laíns Ana Rita Santos Zafer Cebeci Atchara Amphornphruet Valentin Degenhardt Jan Darius Unterlauft Carlo Cagini Valérie Mané-Tauty Giuseppe D’Amico Ricci Isaac Hindi Kushal Agrawal Jay Chhablani Anat Loewenstein Dinah Zur Matus Rehak Biochemistry, Genetics and Molecular Biology Medicine © 2019, Springer-Verlag Italia S.r.l., part of Springer Nature. Aims: To provide 2-year follow-up data on eyes with diabetic macular edema (DME) that were non-responsive after three initial anti-vascular endothelial growth factor (VEGF) injections, comparing functional and anatomical outcomes under continued anti-VEGF therapy versus dexamethasone (DEX) implant. Methods: Multicenter, retrospective chart review comparing eyes with treatment-naïve DME and a suboptimal response to a loading phase of anti-VEGF therapy (3 injections given monthly) which were then treated with (a) further anti-VEGF (n = 72) or (b) initially switched to DEX implant (n = 38). Main outcome measures were change in visual acuity (VA) and central subfield thickness (CST) from the end of the loading phase to 24 months. Results: In 79% of the 12-month study population (87/110 eyes), 24-month data were available. One quarter of eyes in each group switched treatments during the second year. Eyes that were switched early to DEX implant maintained the functional and anatomical improvements at 24 months which were seen in the first year (from month 3: + 8.9 letters, − 214 µm). Eyes that were switched from anti-VEGF therapy to steroids in the second year improved VA and reduced CST at 24 months (from month 12: + 6.8 letters, p = 0.023; − 226 µm, p = 0.004). In eyes continued on anti-VEGF therapy, VA and CST were stable at 24 months (from month 3: + 2.8 letters, p = 0.254; − 24 µm, p = 0.243). Eyes that were non-responsive to anti-VEGF therapy for 12 months had similar chances to experience a VA gain from further therapy as eyes that were non-responsive for 3 months only (23.8 vs. 31.0%, p = 0.344). Conclusions: The beneficial effect of an early switch to DEX implant in DME non-responders seen at month 12 was maintained during the second year. A later switch from anti-VEGF to steroids still provided significant improvement. Eyes continued on anti-VEGF over a period of 24 months maintained vision. A quarter of eyes, which had not improved vision at 12 months, exhibited a delayed response to treatment. 2020-04-02T14:56:30Z 2020-04-02T14:56:30Z 2019-12-01 Journal 14325233 09405429 2-s2.0-85074074965 10.1007/s00592-019-01416-4 https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85074074965&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/67601
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
topic Biochemistry, Genetics and Molecular Biology
Medicine
spellingShingle Biochemistry, Genetics and Molecular Biology
Medicine
Catharina Busch
Samantha Fraser-Bell
Matias Iglicki
Marco Lupidi
Aude Couturier
Voraporn Chaikitmongkol
Ermete Giancipoli
Patricio J. Rodríguez-Valdés
Pierre Henry Gabrielle
Inês Laíns
Ana Rita Santos
Zafer Cebeci
Atchara Amphornphruet
Valentin Degenhardt
Jan Darius Unterlauft
Carlo Cagini
Valérie Mané-Tauty
Giuseppe D’Amico Ricci
Isaac Hindi
Kushal Agrawal
Jay Chhablani
Anat Loewenstein
Dinah Zur
Matus Rehak
Real-world outcomes of non-responding diabetic macular edema treated with continued anti-VEGF therapy versus early switch to dexamethasone implant: 2-year results
description © 2019, Springer-Verlag Italia S.r.l., part of Springer Nature. Aims: To provide 2-year follow-up data on eyes with diabetic macular edema (DME) that were non-responsive after three initial anti-vascular endothelial growth factor (VEGF) injections, comparing functional and anatomical outcomes under continued anti-VEGF therapy versus dexamethasone (DEX) implant. Methods: Multicenter, retrospective chart review comparing eyes with treatment-naïve DME and a suboptimal response to a loading phase of anti-VEGF therapy (3 injections given monthly) which were then treated with (a) further anti-VEGF (n = 72) or (b) initially switched to DEX implant (n = 38). Main outcome measures were change in visual acuity (VA) and central subfield thickness (CST) from the end of the loading phase to 24 months. Results: In 79% of the 12-month study population (87/110 eyes), 24-month data were available. One quarter of eyes in each group switched treatments during the second year. Eyes that were switched early to DEX implant maintained the functional and anatomical improvements at 24 months which were seen in the first year (from month 3: + 8.9 letters, − 214 µm). Eyes that were switched from anti-VEGF therapy to steroids in the second year improved VA and reduced CST at 24 months (from month 12: + 6.8 letters, p = 0.023; − 226 µm, p = 0.004). In eyes continued on anti-VEGF therapy, VA and CST were stable at 24 months (from month 3: + 2.8 letters, p = 0.254; − 24 µm, p = 0.243). Eyes that were non-responsive to anti-VEGF therapy for 12 months had similar chances to experience a VA gain from further therapy as eyes that were non-responsive for 3 months only (23.8 vs. 31.0%, p = 0.344). Conclusions: The beneficial effect of an early switch to DEX implant in DME non-responders seen at month 12 was maintained during the second year. A later switch from anti-VEGF to steroids still provided significant improvement. Eyes continued on anti-VEGF over a period of 24 months maintained vision. A quarter of eyes, which had not improved vision at 12 months, exhibited a delayed response to treatment.
format Journal
author Catharina Busch
Samantha Fraser-Bell
Matias Iglicki
Marco Lupidi
Aude Couturier
Voraporn Chaikitmongkol
Ermete Giancipoli
Patricio J. Rodríguez-Valdés
Pierre Henry Gabrielle
Inês Laíns
Ana Rita Santos
Zafer Cebeci
Atchara Amphornphruet
Valentin Degenhardt
Jan Darius Unterlauft
Carlo Cagini
Valérie Mané-Tauty
Giuseppe D’Amico Ricci
Isaac Hindi
Kushal Agrawal
Jay Chhablani
Anat Loewenstein
Dinah Zur
Matus Rehak
author_facet Catharina Busch
Samantha Fraser-Bell
Matias Iglicki
Marco Lupidi
Aude Couturier
Voraporn Chaikitmongkol
Ermete Giancipoli
Patricio J. Rodríguez-Valdés
Pierre Henry Gabrielle
Inês Laíns
Ana Rita Santos
Zafer Cebeci
Atchara Amphornphruet
Valentin Degenhardt
Jan Darius Unterlauft
Carlo Cagini
Valérie Mané-Tauty
Giuseppe D’Amico Ricci
Isaac Hindi
Kushal Agrawal
Jay Chhablani
Anat Loewenstein
Dinah Zur
Matus Rehak
author_sort Catharina Busch
title Real-world outcomes of non-responding diabetic macular edema treated with continued anti-VEGF therapy versus early switch to dexamethasone implant: 2-year results
title_short Real-world outcomes of non-responding diabetic macular edema treated with continued anti-VEGF therapy versus early switch to dexamethasone implant: 2-year results
title_full Real-world outcomes of non-responding diabetic macular edema treated with continued anti-VEGF therapy versus early switch to dexamethasone implant: 2-year results
title_fullStr Real-world outcomes of non-responding diabetic macular edema treated with continued anti-VEGF therapy versus early switch to dexamethasone implant: 2-year results
title_full_unstemmed Real-world outcomes of non-responding diabetic macular edema treated with continued anti-VEGF therapy versus early switch to dexamethasone implant: 2-year results
title_sort real-world outcomes of non-responding diabetic macular edema treated with continued anti-vegf therapy versus early switch to dexamethasone implant: 2-year results
publishDate 2020
url https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85074074965&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/67601
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