Effect of Aflibercept on Diabetic Retinopathy Severity and Visual Function in the RECOVERY Study for Proliferative Diabetic Retinopathy

Alagorie, Ahmed Roshdy; Velaga, Swetha Bindu; Nittala, Muneeswar Gupta; Yu, Hannah J.; Wykoff, Charles C.

doi:10.1016/j.oret.2020.08.018

Cited by 11 publications

(3 citation statements)

References 27 publications

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“…The non-inferiority of ranibizumab, compared with panretinal photocoagulation to manage PDR was furtherly confirmed by the five-year report of the DRCR network [ 87 ], which also reported relatively higher probability to develop DME and to have worse visual field in laser-treated group. Moreover, the recent RECOVERY study showed a statistically significant impact of anti-VEGF injections (in this case of aflibercept) on the improvement in DR severity progression registered after one year of follow-up in PDR eyes without DME [ 127 ]. Further recent meta-analysis studies provided even more support on the fact that, although not reaching enough level of statistical evidence, the use of anti-VEGF in PDR is associated with better visual outcome and less incidence of PDR-related complications, if compared with panretinal photocoagulation alone [ 131 , 132 ].…”

Section: The Role Of Anti-vegf In Dr-related Retinal Neovascularizationmentioning

confidence: 99%

VEGF-targeting drugs for the treatment of retinal neovascularization in diabetic retinopathy

2022

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Diabetic retinopathy (DR) is the most common microangiopathic complication of diabetes mellitus, representing a major cause of visual impairment in developed countries. Proliferative DR (PDR) represents the last stage of this extremely complex retinal disease, characterized by the development of neovascularization induced by the abnormal production and release of vascular endothelial growth factor (VEGF). The term VEGF includes different isoforms; VEGF-A represents one of the most important pathogenic factors of DR. Anti-VEGF intravitreal therapies radically changed the outcome of DR, due to combined anti-angiogenic and anti-edematous activities. Nowadays, several anti-VEGF molecules exist, characterized by different pharmacological features and duration. With respect to PDR, although anti-VEGF treatments represented a fundamental step forward in the management of this dramatic complication, a big debate is present in the literature regarding the role of anti-VEGF as substitute of panretinal photocoagulation or if these two approaches may be used in combination. In the present review, we provided an update on VEGF isoforms and their role in DR pathogenesis, on current anti-VEGF molecules and emerging new drugs, and on the current management strategies of PDR. There is an overall agreement regarding the relative advantage provided by anti-VEGF, especially looking at the management of PDR patients requiring vitrectomy, with respect to laser. Based on the current data, laser approaches might be avoided when a perfectly planned anti-VEGF therapeutic strategy can be adopted. Conversely, laser treatment may have a role for those patients unable to guarantee enough compliance to anti-VEGF injections. Key messages VEGF increased production, stimulated by retinal hypoperfusion and ischaemia, is a major pathogenic factor of neovascular complication onset in diabetic retinopathy and of DR stages progression. Nowadays, several anti-VEGF molecules are available in clinical practice and other molecules are currently under investigation. Each anti-VEGF molecule is characterized by different targets and may interact with multiple biochemical pathways within the eye. All the data agreed in considering anti-VEGF molecules as a first line choice for the management of diabetic retinopathy. Laser treatments may have a role in selected advanced cases and for those patients unable to guarantee enough compliance to intravitreal treatments schemes.

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Section: The Role Of Anti-vegf In Dr-related Retinal Neovascularizationmentioning

confidence: 99%

VEGF-targeting drugs for the treatment of retinal neovascularization in diabetic retinopathy

2022

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“…Studies [6,10] have demonstrated that intravitreal aflibercept provides a chance for improvement to most patients with decreased vision, with a reduction in the number of injections needed after month 12 of therapy.…”

Section: Resultsmentioning

confidence: 99%

Managing proliferative diabetic retinopathy in a patient with vitreous hemorrhage: a case report

Koshchynets¹,

Vadiuk²

2022

Oftalmol Zh

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“…As far as PDR is concerned, the RECOVERY study (“Intravitreal Aflibercept for Retinal Non-Perfusion in Proliferative Diabetic Retinopathy”) evaluated prospectively the effect of intravitreal 2 mg aflibercept either monthly or quarterly in DRSS and visual function in patients with PDR without DME over a period of 12 months [ 35 ]. The study demonstrated that there was a statistically significant regression in DRSS from baseline to month 12 in both groups, which was associated with improvement in the mean composite score of visual function questionnaires (VFQ)-25 and VFQ-39, while no difference was found between the two groups [ 35 ].…”

Section: Resultsmentioning

confidence: 99%

Intravitreal Anti-Vascular Endothelial Growth Factor Agents for the Treatment of Diabetic Retinopathy: A Review of the Literature

Chatziralli

Loewenstein

2021

Pharmaceutics

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Background: Diabetic retinopathy (DR) is the leading cause of blindness in the working-age population. The purpose of this review is to gather the existing literature regarding the use of the approved anti-vascular endothelial growth (anti-VEGF) agents in the treatment of DR. Methods: A comprehensive literature review in PubMed engine search was performed for articles written in English language up to 1 July 2021, using the keywords “diabetic retinopathy”, “ranibizumab”, “aflibercept”, and “anti-VEGF”. Emphasis was given on pivotal trials and recent robust studies. Results: Intravitreal anti-VEGF agents have been found to significantly improve visual acuity and reduce retinal thickness in patients with diabetic macular edema (DME) in a long-term follow-up ranging from 1 to 5 years and are considered the standard-of-care in such patients. Regarding DR, intravitreal anti-VEGF agents provided ≥2-step improvement in DR severity on color fundus photography in about 30–35% of patients with NPDR at baseline, in the majority of clinical trials originally designed to evaluate the efficacy of intravitreal anti-VEGF agents in patients with DME. Protocol S and CLARITY study have firstly reported that intravitreal anti-VEGF agents are non-inferior to panretinal photocoagulation (PRP) in patients with proliferative DR (PDR). However, the use of new imaging modalities, such as optical coherence tomography-angiography and wide-field fluorescein angiography, reveals conflicting results about the impact of anti-VEGF agents on the regression of retinal non-perfusion in patients with DR. Furthermore, one should consider the high “loss to follow-up” rate and its devastating consequences especially in patients with PDR, when deciding to treat the latter with intravitreal anti-VEGF agents alone compared to PRP. In patients with PDR, combination of treatment of intravitreal anti-VEGF agents and PRP has been also supported. Moreover, in the specific case of vitreous hemorrhage or tractional retinal detachment as complications of PDR, intravitreal anti-VEGF agents have been found to be beneficial as an adjunct to pars plana vitrectomy (PPV), most commonly given 3–7 days before PPV, offering reduction in the recurrence of vitreous hemorrhage. Conclusions: There is no general consensus regarding the use of intravitreal anti-VEGF agents in patients with DR. Although anti-VEGF agents are the gold standard in the treatment of DME and seem to improve DR severity, challenges in their use exist and should be taken into account in the decision of treatment, based on an individualized approach.

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Effect of Aflibercept on Diabetic Retinopathy Severity and Visual Function in the RECOVERY Study for Proliferative Diabetic Retinopathy

Cited by 11 publications

References 27 publications

VEGF-targeting drugs for the treatment of retinal neovascularization in diabetic retinopathy

VEGF-targeting drugs for the treatment of retinal neovascularization in diabetic retinopathy

Managing proliferative diabetic retinopathy in a patient with vitreous hemorrhage: a case report

Intravitreal Anti-Vascular Endothelial Growth Factor Agents for the Treatment of Diabetic Retinopathy: A Review of the Literature

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