Differential response to intravitreal dexamethasone implant in naïve and previously treated diabetic macular edema eyes

Abstract

Background: To identify different response patterns to intravitreal dexamethasone implants (IDI) in naïve and previously treated (PT) diabetic macular edema (DME) eyes in a real-life setting.Methods: 342 IDI injections (203 DME eyes) were included. Number of IDI injections, percentage (%) of eyes with 1, 2, 3 and ³ 4 injections, time to reinjections, visual acuity (VA), intraocular pressure (IOP) and central retinal thickness (CRT) were evaluated for naïve and PT DME eyes over 24 months.Results: Mean number of injections was significantly lower in naïve vs PT DME eyes (1.40±0.9 vs 1.82±0.9, p<0.001). The percentage of eyes receiving 1 injection was significantly higher in naïve vs PT DME eyes (76.1 vs 47.7), (p<0.001). However, it was significantly lower for 2 (16.4 vs 29.4), or 3 injections (1.4 vs 17.6) (both p<0.001), with no differences in eyes receiving ³4 injections (5.9 vs 5.1 respectively, p=0.80). Mean time to reinjection was not significantly different between both groups for the second, third and fourth injection (9.6±4.0 vs 10.0±5.5, p=0.75, 13.2±4.0 vs 16.0±3.5, p=0.21 and 21.7±3.8 vs 19.7±5.8, p=0.55). VA scores were consistently better in naïve vs PT DME eyes at all studied timepoints, with no significant differences in CRT reduction or adverse effect rates.Conclusion: Naïve DME eyes received lower number of IDI injections and showed better VA levels than PT DME eyes for 24 months in a real-world setting. This data supports the IDI use in early DME stages and provide further evidence of better IDI response when used as first-line therapy.

Dexamethasone Implant for Diabetic Macular Oedema: 1-Year Treatment Outcomes from the Fight Retinal Blindness! Registry

“…A few studies have evaluated treatment outcomes of dexamethasone implant for DMO in routine clinical practice after 12 months from the start of treatment [9,12,13,22]. These studies have reported a mean VA gain ranging from ?…”

“…The intravitreal bevacizumab vs. intravitreal dexamethasone for DMO (BEV-ORDEX) study found that the proportion of eyes with vision improvement at 12 months was similar in the two groups from a mean number of injections of 2.7 in the dexamethasone and 8.6 in the bevacizumab group [8]. Some studies that reported the outcomes of the dexamethasone implant for DMO in routine clinical practice found that the implant was safe and effective in improving visual acuity and reducing macular thickness from a few injections [9][10][11][12][13]. This study aimed to report visual acuity, anatomic outcomes, proportion of eyes that received dexamethasone implant and the number of dexamethasone implants over the first year of treatment in eyes with DMO in routine clinical practice.…”

Healthcare expenditure of intravitreal anti‐vascular endothelial growth factor inhibitors compared with dexamethasone implant for diabetic macular oedema

“…However, dexamethasone may cause high intraocular pressure with almost 22% of the patients exhibiting elevated pressure requiring medical treatment, as well as cataract progression. These adverse events may necessitate more frequent care and close monitoring among highrisk patients (Gillies et al 2014;Shah & Heier 2016;He et al 2018;Zarranz-Ventura et al 2020). Our sensitivity analysis found that at our baseline bevacizumab frequency of care or lower, beyond 3 dexamethasone visits increased the cost of annual treatment on average in both patient groups.…”

“… 2018 ; Zarranz‐Ventura et al. 2020 ). Our sensitivity analysis found that at our baseline bevacizumab frequency of care or lower, beyond 3 dexamethasone visits increased the cost of annual treatment on average in both patient groups.…”

“…In line with the literature, we assumed three dexamethasone injections were given over the 1-year period, irrespective of Naive or Switch patient groups. In addition, we assumed that every injection of dexamethasone was followed by one visit to measure intraocular pressure and that 22% required topical pressure-lowering treatment (Zarranz-Ventura et al 2020). Optical coherence tomography (OCT)/visual acuity measures were assumed to take place on the same day as the injection for all drugs.…”