Effectiveness and safety of fluocinolone acetonide intravitreal implant in diabetic macular edema patients considered insufficiently responsive to available therapies (REACT): a prospective, non-randomized, and multicenter study

Abstract

Objective To assess the effectiveness and safety of the intravitreal fluocinolone-acetonide implant (FAc-i) in patients with chronic diabetic macular edema who did not sufficiently respond to other available therapies. Methods This was a multicenter, prospective, non-randomized, and phase-IV observational study conducted on patients with recurrent-DME who were insufficient responders to currently available therapies (REACT-Study). The primary end-point was the mean change in best-corrected-visual-acuity from baseline to month-24 values. Results Thirty-one eyes from 31 patients were included in the study. Mean age was 68.0 ± 7.7 years, and 10 (32.3%) were women. Study patients had received 5.3 ± 7.3 previous DME treatments before starting the study. In the overall study sample, BCVA improved from 56.1 ± 12.3 letters at baseline to 62.4 ± 17.0 letters at month-24 (p = 0.0510). The eyes with a baseline BCVA < 70 ETDRS letters had a significant improvement in BCVA from 53.2 ± 10.2 letters at baseline to 61.5 ± 17.9 letters at month-24 (p = 0.0165). In the overall study population, central-subfoveal-thickness (CST) was significantly reduced from 474.0 ± 135.1 µm at baseline to 333.4 ± 135.6 at month-24 (p < 0.0001). Similarly, macular-volume (MV) was significantly reduced from 10.7 ± 2.7 mm3 at baseline to 9.6 ± 2.9 mm3 (p = 0.0027) at month-24. Among the 31 study eyes, 19 (61.3%) required an additional treatment for DME. Throughout the study, 9 (29.0%) eyes required ocular hypotensive medication for controlling their intraocular-pressure and 5 (16.1%) eyes underwent cataract surgery. Conclusions In DME eyes who did not sufficiently respond to previous therapies, the FAc-i was associated with an improvement in visual and anatomic outcomes. There were no unexpected adverse-events. Trial registration number EudraCT identifier: 2016-001680-37.

Progress in the Treatment of DME

“…In fact, anatomical recurrence of DME may occur approximately 4 -5 months after DEX injection, followed by rapid onset of dysfunction. [69] suggests that early treatment with corticosteroids may be considered in first-treatment patients, but that clinically adjusted re-injection intervals based on patient need may be effective in ensuring maximal improvement in VA and anatomy.…”

“…Patient treatment burden was reduced by 70.5%, 25% of DME patients did not need to be re-treated, and IOP fluctuations were low, maintaining a favorable safety profile [73]. REACT study evaluated the efficacy and safety of FA treatment in patients with chronic DME who had an inadequate response to other treatments, with significant improvement in BCVA, CST and MV at month 24 after FAc injection and no additional adverse events [69]. In the ILUVI1MOIS study, switching to FAc injections 1 month after the last DEX-I in patients with chronic DME (recurrence X. Y. Zou et al…”