For Moderate or Severe Diabetic Macular Edema, Eylea Is Best

Adam Glassman, M.S. Director, DRCRnet Coordinating Center Jaeb Center for Health Research Tampa, FL 33647MedicalResearch.com Interview with:
Adam Glassman, M.S.
Director, DRCRnet Coordinating Center
Jaeb Center for Health Research
Tampa, FL 33647

 

Medical Research: What is the background for this study? What are the main findings?

Response: Diabetic macular edema (DME) is the most common cause of vision loss in patients with diabetes, impairing the vision of approximately 750,000 people in the United States.  The most common treatment involves the injection into the eye of one of 3 drugs that inhibit vascular endothelial growth factor (VEGF). The relative effectiveness and safety of these 3 drugs, Eylea, Avastin and Lucentis were unknown.  We compared the 3 drugs by randomly assigning 660 patients with center-involved Diabetic macular edema and vision loss to receive injections of either Eylea, Avastin, or Lucentis as often as every 4 weeks (according to protocol defined retreatment criteria) for one year.  The results showed that all three drugs, on average, improved vision in eyes with Diabetic macular edema.  However, in eyes with moderate or worse vision loss, Eylea was more effective, on average, at improving vision than the other two drugs.  In eyes with mild vision loss at baseline (20/32 to 20/40), the average gain in vision was similar with all 3 drugs.

Medical Research: What should clinicians and patients take away from your report?

Response: This study should help doctors and patients make informed treatment decisions regarding the management of diabetic macular edema.  The results are reassuring in that all drugs have been shown to be effective at improving vision and that all 3 drugs are equally safe, so doctors can confidently use any one of the drugs to treat diabetic macular edema.  All drugs performed similarly, on average, when baseline vision loss was mild. Eyes with worse initial vision improved more with Eylea than the other drugs. However, the choice of drug in an individual patient requires consideration of cost, insurance coverage and other factors not addressed in our study.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: The current study is continuing for a second year for each participant to assess the longer term comparative effectiveness of the three drugs.  Previous studies using ranibizumab showed a smaller number of injections in the second year of diabetic macular edema treatment than in the first, so it will be interesting to see if this the current study shows similar results for all three drugs.  In addition, in all three treatment groups there was a proportion of eyes in which diabetic macular edema did not completely resolve within the first year of treatment.  It would be interesting to know why DME sometimes persists in particular eyes even with anti-VEGF therapy and what other treatment options may be available for this unique cohort.

Citation:

Aflibercept, Bevacizumab, or Ranibizumab for Diabetic Macular Edema

The Diabetic Retinopathy Clinical Research Network

February 18, 2015DOI: 10.1056/NEJMoa141426

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MedicalResearch.com Interview with:, & Adam Glassman, M.S. (2015). For Moderate or Severe Diabetic Macular Edema, Eylea Is Best MedicalResearch.com

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