Anti-VEGFs as a Treatment for Diabetic Retinopathy and PANORAMA Results

While their impact has been shown in treating neovascular age-related macular degeneration (nAMD), there has been little evidence of whether or not anti-VEGF therapies could be used to treat patients with nonproliferative diabetic retinopathy and without diabetic macular edema (DME).

W. Lloyd Clark, MD, of the Palmetto Retina Center, presented 52-week results of the PANORAMA study at the 2019 American Society of Retina Specialists Annual Meeting, which found that treatment with intravitreal aflibercept injections could reverse disease progression in patients with moderately severe to severe NPDR.

The phase 3 study, which enrolled a total of 402 patients, was designed as a double-masked, randomized study for patients 18 or older with diabetes mellitus type 1 or 2. For inclusion, participants had to have a Diabetic Retinopathy Severity Scale score of 47 to 53, an absence of center-involved DME, and a baseline best-corrected visual acuity of 69 or more letters in the study eye. 



Patients were randomized to receive 2 mg aflibercept injections every 8 weeks following 5 monthly doses (134), 2 mg aflibercept every 16 weeks following 3 monthly doses AND aflibercept every 18 weeks (135), or sham (133).

Investigators in the study found that the proportion of patients who developed vision-threatening complications was significantly lower in both aflibercept groups (3% in the 8-week group, 4% in the 16 week group) than sham (20%).

Additionally, the incidence rate of center-involved DME was also significantly lower in aflibercept groups compared with sham.

In between sessions at ASRS 2019, Clark sat down with MD Magazine to discuss the clinical implications of the study results. 



MD Mag: What were the results of the PANORAMA study?




Clark: So, the PANORAMA study was a clinical trial designed to evaluate the role of anti-VEGF therapy in the regression of diabetic retinopathy. There's been observations and other clinical trials as secondary endpoints that treatment with anti-VEGF agents can actually reduce the severity of diabetic retinopathy in patients. 


So, this was a trial specifically designed to answer the question as to whether or not specific dosing intervals of aflibercept — in this case— would reduce the severity of diabetic retinopathy and this patient population was a very specific group of patients — patients that either had moderately severe to severe nonproliferative disease or what we call level 47 to level 53 on the early treatment diabetic retinopathy severity scale.