AntiVEGF Therapy for the Management of Diabetic M

Authors: Marianeli Rodriguez Philip Storey Diana V Do

Publish Date: 2013/07/25

Volume: 1, Issue: 3, Pages: 122-127

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Abstract

To review the medical evidence for the use of intravitreal vascular endothelial growth factor VEGF inhibitors for the treatment of diabetic macular edema DME Evaluation of randomized clinical trials evaluating VEGF inhibitors for centerinvolved DME Ranibizumab an antiVEGF antibody fragment was evaluated in two phase III clinical studies entitled RISE and RIDE At 24 months significantly more ranibizumab treated patients gained ≥15 letters in vision as compared to the sham group 448 and 392  vs 181  P  00001 The ranibizumab group improved a mean of 2506–2707 µm in central foveal thickness compared to a mean improvement of 1258–1334 µm for the sham group In addition ranibizumab treated patients were more likely to have improvement in retinopathy Additional clinical trials have evaluated bevacizumab another antiVEGF antibody fragment and aflibercept a fusion protein that blocks VEGF Both bevacizumab and aflibercept have also resulted in superior visual acuity outcomes compared to focal laser photocoagulation All three agents appear to be safe though these clinical trials were not powered to evaluate safety as a primary outcome Recent clinical trials have demonstrated the superior outcomes with antiVEGF agents compared to laser alone or sham treatment Bevacizumab ranibizumab and aflibercept have all shown remarkable improvements in both visual acuity outcomes and retinal thickness reductionsDiabetic maculopathy causes the majority of visual loss in patients with diabetic retinopathy 1 The Wisconsin epidemiologic study of diabetic retinopathy WESDR reported a 98  rate of retinopathy in Americans with type 1 diabetes with the disease for more than 15 years and a rate of 78  for Americans with type 2 diabetes 2 The WESDR reported a 28  prevalence of diabetic macular edema DME 20 years after initial diagnosis of type 1 or 2 diabetes 3 With the prevalence of diabetes mellitus expected to increase from 180 million people to 300 million people worldwide by 2025 diabetic retinopathy and macular edema will become more prevalent as well 4

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