Intravitreal Aflibercept Injection in Diabetic Macular Edema Patients with and without Prior Anti-Vascular Endothelial Growth Factor Treatment: Outcomes from the Phase 3 Program

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• 作者：Diana V. Do ; MD¹ ; ^{diana.do@unmc.edu" class="auth_mail" title="E-mail the corresponding author} ; Quan Dong Nguyen ; MD ; MSc¹ ; Robert Vitti ; MD² ; Alyson J. Berliner ; MD ; PhD² ; Andrea Gibson ; PhD² ; Namrata Saroj ; OD² ; Yuhwen Soo ; PhD² ; David S. Boyer ; MD³
• 关键词：BCVA ; best-corrected visual acuity ; CST ; central subfield thickness ; DME ; diabetic macular edema ; DRSS ; Diabetic Retinopathy Severity Scale ; ETDRS ; Early Treatment Diabetic Retinopathy Study ; IAI ; intravitreal aflibercept injection ; SD ; standard deviation ; VEGF ; vascular endothelial growth factor
• 刊名：Ophthalmology
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：123
• 期：4
• 页码：850-857
• 全文大小：1044 K

文摘

To evaluate visual and anatomic outcomes after intravitreal aflibercept injection (IAI) versus laser in diabetic macular edema (DME) patients with and without prior anti–vascular endothelial growth factor (VEGF) treatment for DME.

Design

Post hoc analysis of eyes from 2 similarly designed, phase 3 trials, VISTA and VIVID.

Participants

Patients (eyes) with DME with central involvement from VISTA (n = 461) and VIVID (n = 404).

Methods

Eyes received IAI 2 mg every 4 weeks (2q4), IAI 2 mg every 8 weeks after 5 monthly doses (2q8), or macular laser photocoagulation.

Main Outcome Measures

This study reports exploratory outcomes through week 100. Analyses focused on VISTA because more patients received prior anti-VEGF therapy in VISTA (42.9%) versus VIVID (8.9%).

Results

Of 42.9% of patients in VISTA who received prior anti-VEGF treatment, 83.3% to 92.6% received ≥ 1 prior injections of bevacizumab, and 71.4% to 82.4% received bevacizumab only as prior anti-VEGF treatment for a duration ranging from 28 days to 3.9 years. In patients with prior anti-VEGF treatment, mean best-corrected visual acuity (BCVA) changes from baseline in the IAI 2q4, IAI 2q8, and laser groups were +10.4 letters, +10.5 letters, and −0.7 letters at week 52 and +10.9 letters, +10.8 letters, and −0.8 letters at week 100, respectively. Corresponding changes in patients without prior anti-VEGF treatment were +14.1 letters, +11.0 letters, and +0.9 letters at week 52 and +12.0 letters, +11.3 letters, and +2.1 letters at week 100. In patients with prior anti-VEGF treatment, mean reductions in central retinal thickness were 180.2 μm, 192.2 μm, and 90.9 μm at week 52 and 180.1 μm, 196.4 μm, and 94.1 μm at week 100. Corresponding reductions in patients without prior anti-VEGF treatment were 190.3 μm, 175.7 μm, and 61.0 μm at week 52 and 200.0 μm, 186.7 μm, and 76.9 μm at week 100. The most frequent serious ocular adverse event was vitreous hemorrhage (1.3%, 0.7%, and 1.9%, respectively).

Conclusions

Visual and anatomic improvements over laser with both IAI regimens were significant and similar through week 100 in subgroups of patients in VISTA with and without prior anti-VEGF treatment for DME.