Aflibercept, bevacizumab or ranibizumab for diabetic macular oedema

Cai, Sophie; Bressler, Neil M.

doi:10.1097/icu.0000000000000424

Cited by 147 publications

(75 citation statements)

References 38 publications

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“…Reductions in markers of inflammation have also been documented in human diabetic retinopathy (132,133), and micropulsed laser treatment has been demonstrated to improved early forms of macular edema with significant improvement in vision and without evidence of laser injury (133)(134)(135). When the macular edema is more severe, however, similar to the studies of intravitreal anti-VEGF injections, the studies of micropulsed laser demonstrate only minimal improvement in the edema and in vision (presumably because of the already established, irreversible neurodegeneration) (11,133). Studies are underway to investigate the ability of this non-invasive treatment to retard the progressive neuronal apoptosis and vision loss and progression of the microangiopathy when treatment is applied early and repeatedly.…”

Section: Treatment/prevention Of Neurodegenerationmentioning

confidence: 89%

“…Meaningful treatment of diabetic retinopathy has been limited by failure to recognize the neurovascular condition which precedes and then continues in parallel with the progressive microangiopathy (18)(19)(20)(21)(22)(23). For example, although anti-VEFG therapies are initiated for treating all manner of retinopathy with observed retinal central thickening, they only result in modest, and very often transient, improvement of visual acuity (10)(11)(12).…”

Section: Implications For Diabetic Retinopathy Diagnostic Screening Amentioning

confidence: 99%

“…Of note, diabetic retinopathy is the leading cause of blindness in the adult working population (7,9). Although retinopathy is common, poor patient compliance with yearly ocular screening (only 35-55% compliance) and techniques which rely on physician examination of the retina or retinal photography focused on vascular changes, detection is often delayed until after severe damage has occurred and treatments are unable to substantively restore vision (only 25-28% demonstrating improvement of ≥3 ETDRS lines) (10)(11)(12)(13)(14)(15). Indeed, visual examination by optometrists or ophthalmologists detect only very poorly vascular changes (most often when they occur with intra-retinal hemorrhages) and physician examinations cannot easily or precisely define progressive changes over time.…”

Section: Introductionmentioning

confidence: 99%

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Diabetic Retinopathy–An Underdiagnosed and Undertreated Inflammatory, Neuro-Vascular Complication of Diabetes

Sinclair

Schwartz

2019

Front. Endocrinol.

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Diabetes mellitus is a world-wide epidemic and diabetic retinopathy, a devastating, vision-threatening condition, is one of the most common diabetes-specific complications. Diabetic retinopathy is now recognized to be an inflammatory, neuro-vascular complication with neuronal injury/dysfunction preceding clinical microvascular damage. Importantly, the same pathophysiologic mechanisms that damage the pancreatic β-cell (e.g., inflammation, epigenetic changes, insulin resistance, fuel excess, and abnormal metabolic environment), also lead to cell and tissue damage causing organ dysfunction, elevating the risk of all complications, including diabetic retinopathy. Viewing diabetic retinopathy within the context whereby diabetes and all its complications arise from common pathophysiologic factors allows for the consideration of a wider array of potential ocular as well as systemic treatments for this common and devastating complication. Moreover, it also raises the importance of the need for methods that will provide more timely detection and prediction of the course in order to address early damage to the neurovascular unit prior to the clinical observation of microangiopathy. Currently, treatment success is limited as it is often initiated far too late and after significant neurodegeneration has occurred. This forward-thinking approach of earlier detection and treatment with a wider array of possible therapies broadens the physician's armamentarium and increases the opportunity for prevention and early treatment of diabetic retinopathy with preservation of good vision, as well the prevention of similar destructive processes occurring among other organs.

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Section: Treatment/prevention Of Neurodegenerationmentioning

confidence: 89%

Section: Implications For Diabetic Retinopathy Diagnostic Screening Amentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diabetic Retinopathy–An Underdiagnosed and Undertreated Inflammatory, Neuro-Vascular Complication of Diabetes

Sinclair

Schwartz

2019

Front. Endocrinol.

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“…When there is moderate or worse VA loss, aflibercept is more efficacious. 120 Bevacizumab remains more cost-effective than ranibizumab or aflibercept. 121 For PDR management, the role of anti-VEGF and laser therapy is different than that for DME.…”

Section: Anti-vegf Therapymentioning

confidence: 99%

<p>The Evolving Treatment of Diabetic Retinopathy</p>

Mansour¹,

Browning²,

Wong³

et al. 2020

OPTH

162

134

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Purpose: To review the current therapeutic options for the management of diabetic retinopathy (DR) and diabetic macular edema (DME) and examine the evidence for integration of laser and pharmacotherapy. Methods: A review of the PubMed database was performed using the search terms diabetic retinopathy, diabetic macular edema, neovascularization, laser photocoagulation, intravitreal injection, vascular endothelial growth factor (VEGF), vitrectomy, pars plana vitreous surgery, antiangiogenic therapy. With additional cross-referencing, this yielded 835 publications of which 301 were selected based on content and relevance. Results: Many recent studies have evaluated the pharmacological, laser and surgical therapeutic strategies for the treatment and prevention of DR and DME. Several newer diagnostic systems such as optical coherence tomography (OCT), microperimetry, and multifocal electroretinography (mfERG) are also assisting in further refinements in the staging and classification of DR and DME. Pharmacological therapies for both DR and DME include both systemic and ocular agents. Systemic agents that promote intensive glycemic control, control of dyslipidemia and antagonists of the renin-angiotensin system demonstrate beneficial effects for both DR and DME. Ocular therapies include anti-VEGF agents, corticosteroids and nonsteroidal anti-inflammatory drugs. Laser therapy, both as panretinal and focal or grid applications continue to be employed in management of DR and DME. Refinements in laser devices have yielded more tissue-sparing (subthreshold) modes in which many of the benefits of conventional continuous wave (CW) lasers can be obtained without the adverse side effects. Recent attempts to lessen the burden of anti-VEGF injections by integrating laser therapy have met with mixed results. Increasingly, vitreoretinal surgical techniques are employed for less advanced stages of DR and DME. The development and use of smaller gauge instrumentation and advanced anesthesia agents have been associated with a trend toward earlier surgical intervention for diabetic retinopathy. Several novel drug delivery strategies are currently being examined with the goal of decreasing the therapeutic burden of monthly intravitreal injections. These fall into one of the five categories: non-biodegradable polymeric drug delivery systems, biodegradable polymeric drug delivery systems, nanoparticle-based drug delivery systems, ocular injection devices and with sustained release refillable devices. At present, there remains no one single strategy for the management of the particular stages of DR and DME as there are many options that have not been rigorously tested through large, randomized, controlled clinical trials. Conclusion: Pharmacotherapy, both ocular and systemic, will be the primary mode of intervention in the management of DR and DME in many cases when cost and treatment burden are less constrained. Conventional laser therapy has become a secondary intervention in these instances, but remains a first-line option when cost and ...

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“…Chimeric monoclonal antibodies (bevacizumab, ranibizumab) and decoy receptors (aflibercept) have indeed been developed towards VEGF and have been widely used therapeutically: anti-VEGF therapy has revolutionized the prognosis of wet AMD [208][209][210] , and is an established treatment modality for different retinal diseases such as diabetic macular edema 211 and RVO 212 , although repeated treatment (typically monthly intravitreal injections) are required in order to sustain angiogenic suppression. Moreover, therapy fails in at least 20% of cases 208,209 .…”

Section: Anti-vegf Treatmentmentioning

confidence: 99%

Inhibitors of corneal inflammation and angiogenesis : Prospectives and challenges

Mirabelli

2019

Linköping University Medical Dissertations

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row: photography of vessels in a cornea (false colours); computer elaboration of the vessels; HE histology of cornea with vessels and inflammatory cells; middle row: vessels and inflammatory cells seen with IVCM; lower row: HUVEC cells stained for VEGF; immunofluorescence of neovascularized cornea stained for CD31 and NFκB. Other illustrations in the thesis by Anthony Mukwaya, Per Lagman, Pierfrancesco Mirabelli. This thesis contains original material, and material reprinted from previously published work, published under a CC BY license (Creative Commons Attribution 4.0 International License), which allows for maximum dissemination and re-use of open access materials. IKE, Linköping university iv v …Instruction, and not silver; and Knowledge rather than choice gold. For Wisdom is better than rubies… (Proverbs 8: 10-11) vi vii ABSTRACT Pathologic angiogenesis is involved in cancer and several blinding conditions such as wet age-related macular degeneration, proliferative retinopathies and corneal neovascularization. In these dieseases, the angiogenic triggers are hypoxia and inflammation, and both involve the main angiogenic mediator, which is Vascular Endothelial Growth Factor (VEGF). Among available treatments, anti-VEGF often shows limited or temporary efficacy, while steroids are potentially responsible for many side-effects. This thesis presents a series of linked studies aimed at elucidating the early pathologic changes leading to inflammation and corneal neovascularization, and how various treatments affect this process. In this thesis, xii xiii LIST OF PUBLICATIONS INCLUDED IN THE THESIS PAPER I Early effects of dexamethasone and anti-VEGF therapy in an inflammatory corneal neovascularization model. Mirabelli P, Peebo BB, Xeroudaki M, Koulikovska M, Lagali N. Exp Eye Res.

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Aflibercept, bevacizumab or ranibizumab for diabetic macular oedema

Abstract: When initial visual acuity loss is mild, there are no apparent differences, on average, among aflibercept, bevacizumab and ranibizumab for treating DME. When visual acuity loss is moderate or worse, aflibercept is more likely to improve visual acuity.

Cited by 147 publications

References 38 publications

Diabetic Retinopathy–An Underdiagnosed and Undertreated Inflammatory, Neuro-Vascular Complication of Diabetes

Diabetic Retinopathy–An Underdiagnosed and Undertreated Inflammatory, Neuro-Vascular Complication of Diabetes

<p>The Evolving Treatment of Diabetic Retinopathy</p>

Inhibitors of corneal inflammation and angiogenesis : Prospectives and challenges

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