What Influences Diabetic Macular Edema Resolution with Anti-VEGF?

Kevin Kunzmann

An assessment of VISTA and VIVID patient data uncovered surprising risk factors associated with aflibercept success or failure in DME resolution.

A new study from Cleveland Clinic investigators indicated that patients with diabetic macular edema (DME) were nearly 3 times as likely to achieve disease resolution when treated with intravitreal aflibercept injection versus those treated with laser control therapy.

In an assessment presented at the Association for Research in Vision and Ophthalmology (ARVO) 2021 Virtual Sessions this week, Katherine Talcott, MD, of the Cleveland Clinic’s Cole Eye Institute, reported that patient DME data from the VISTA and VIVID clinical trials, stratified by baseline factors of disease status, indicated exactly who may receive the most benefit from the anti-VEGF injection therapy.

Talcott and colleagues sought to interpret a litany of baseline factors’ influence in 862 patients seeking to achieve first DME resolution in long-term care with either 2mg aflibercept (n = 558) or laser control (n = 274). Baseline factors for assessment included: age; gender; race; ethnicity; diabetes type and duration; HbA1c level; hypertension; hyperlipidemia; smoking status; CST; best-corrected visual acuity (BCVA); and DRSS.

Chief among the team’s findings were that patients treated with aflibercept reported a 2.5-fold greater rate of DME resolution versus the laser control arm, with a median 33.0 weeks to achievement versus those who had not achieved resolution in the control arm.

Additionally, multivariate findings indicated thicker CST and better BCVA at baseline were associated with longer duration until DME resolution, as well as less likelihood of duration, in aflibercept-treated patients.

In an interview with HCPLive during ARVO 2021, Talcott discussed the impact of her team’s findings, and how they may help prescribing clinicians better predict which patients with DME will, and will not, respond best to topline anti-VEGF therapy.

Their original anticipation that baseline diabetic retinopathy status would play a major role in DME resolution was debunked by the surprising findings.

“We were actually wondering if the severity of diabetes would affect whether their DME cleared,” Talcott explained. “And interestingly, it didn’t affect it at all. I think it’s interesting—some of the preconceptions we have as clinicians as to how individual patients might do don’t necessarily pan out when you conduct these large studies.”

The study, “Baseline Factors Influencing Resolution of Diabetic Macular Edema (DME) Following Treatment with Intravitreal Aflibercept Injection (IAI) or Laser in VISTA and VIVID,” was presented at ARVO 2021.