Ranibizumab for Persistent Diabetic Macular Edema after Bevacizumab Treatment

Katz, Gabriel; Moisseiev, Elad; Goldenberg, Dafna; Moisseiev, Joseph; Lomnicky, Yosef; Abend, Yitzchak; Treister, Giora; Levkovitch-Verbin, Hani

doi:10.5301/ejo.5000838

Cited by 21 publications

(15 citation statements)

References 13 publications

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“…By analyzing the results according to the patient's baseline status, we found, in the anti-VEGF studies, a mean gain of + 5 letters for 5.2 IVI in naïve patients (BVA 56 letters) [ 15 , 19 , 24 , 27 , 28 , 30 , 37 ] and + 4.8 letters for 6.2 IVI in patients non-naïve to one or more previous treatments (BVA 56.9 letters) [ 16 , 20 , 21 , 23 , 29 , 31 , 32 , 38 , 42 ].…”

Section: Resultsmentioning

confidence: 99%

“…Finally, for subgroups with high BVA (>60 letters), there is a mean gain of + 3.1 letters in the anti-VEGF studies [ 16 – 18 , 20 , 22 , 30 , 31 , 34 , 40 – 42 , 44 ] (mean BVA of 65.3 letters) and + 8.8 letters in the DEX-implant studies [ 51 , 59 , 60 , 74 ] (BVA mean of 68.4 letters). Mean follow-up was, respectively, 13.5 months for a mean of 6.5 IVI and 9 months for a mean of 1.8 IVI ( Figure 7 ) ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…This lower level of VA in the DEX studies may relate to the fact that DEX-implant remains a second-line treatment in routine practice [ 8 ], thus explaining that the patients included in these studies are mostly non-naïve patients, with a long duration of DME, and therefore lower VA. Regarding the studies selected here, 9/32 anti-VEGF studies only concern non-naïve patients [ 16 , 20 , 21 , 23 , 29 , 31 , 32 , 38 , 42 ] with a mean duration of DME of 30.5 months, compared to 19/31 for DEX studies [ 13 , 26 , 46 , 47 , 49 – 57 , 64 , 69 – 73 ] with a similar duration of DME (26.8 months). Nevertheless, the mean numbers of treatments are quite different between the anti-VEGF studies and DEX studies with a mean number of 10.7 and 5.4 treatments before switching, respectively, which could constitute a bias.…”

Section: Discussionmentioning

confidence: 99%

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Pharmacological Management of Diabetic Macular Edema in Real-Life Observational Studies

Kodjikian

Bellocq

Mathis

2018

BioMed Research International

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Objectives of the Study Summary of observational studies concerning the pharmacological management of diabetic macular edema (DME). Methods A literature review was conducted using the PubMed database on 1 February 2018 to identify studies evaluating the efficacy of anti-VEGF and dexamethasone (DEX) implants for DME. Studies with more than 10 patients and follow-up of more than 6 months were selected. Analyses were carried out on the overall population and on subgroups defined according to baseline visual acuity (BVA) and the patients' naïve or non-naïve status. Results Thirty-two studies evaluating the efficacy of anti-VEGF and 31 studies evaluating the efficacy of DEX-implants were retained, concerning 6,842 and 1,703 eyes, respectively. A mean gain of +4.7 letters for a mean of 5.8 injections (mean follow-up: 15.6 months) and +9.6 letters for a mean of 1.6 injections (10.3 months) was found in the anti-VEGF and DEX-implant studies, respectively. Final VA appears to be similar for both treatment (62 letters for anti-VEGF, 61.2 letters for DEX-implant), and BVA appears lower for DEX-implant, which may partially explain the greater visual gain. The DEX-implant studies show greater gains in VA compared to the anti-VEGF studies, especially for higher BVA. Indeed, mean gains for the subgroups of patients with BVA<50 letters, 5060 letters are +4.3, +5.8, and +3.1 letters, respectively, in the anti-VEGF studies and +10.5, +9.3, and +8.8 letters, respectively, in the DEX-implant studies. Regarding the patient's initial status, only naïve status appears to confer the best functional response in DEX-implant studies. Conclusion Observational studies investigating DEX-implant report clinically similar final VA when compared to anti-VEGF, but superior visual gains in real-life practice. This latter difference could be due to the better BVA, but also to the fact that less injections were administered in the anti-VEGF observational studies than in the interventional studies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pharmacological Management of Diabetic Macular Edema in Real-Life Observational Studies

Kodjikian

Bellocq

Mathis

2018

BioMed Research International

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“…There are several reports of improved anatomical and functional outcomes in DME patients who did not respond to one anti-VEGF agent and were then switched to another anti-VEGF agent or received intravitreal steroid therapy [35][36][37][38][39][40] . However, the definition of treatment failure, the timing of treatment change, and the choice of an alternative treatment are variable, and there are no clear guidelines for them, and no high-quality evidence from randomized controlled trials.…”

Section: Existing Dme Treatment Algorithmsmentioning

confidence: 99%

Diabetic Macular Edema: Emerging Strategies and Treatment Algorithms

Moisseiev¹,

Loewenstein²

2017

Management of Diabetic Retinopathy

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Diabetic macular edema (DME) is the most common cause of vision loss in diabetic patients, and its management is often a long process requiring frequent monitoring and therapeutic interventions. During the past several decades, numerous treatments have been developed for the treatment of DME. Although many of them have been found to be effective and safe, there is relatively little comparative data, and no established guidelines for the optimal treatment approach exist. In this chapter, the evolution of DME therapies is reviewed, and the current common practice patterns are discussed. Available data from clinical trials on the commonly used agents, as well as comparative studies and combination therapies are reviewed. Additionally, recent advances and novel treatment options that are currently being investigated are also discussed.

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“…Katz et al retrospectively assessed the efficacy of switching to ranibizumab in patients with refractory DME. 27 In their study, 40 eyes of 32 patients with refractory DME who were initially treated with intravitreal bevacizumab were included. They showed that the CST was significantly reduced, but the improvement in visual acuity was not statistically significant following the conversion from bevacizumab to ranibizumab.…”

Section: Anti-vegf Switchingmentioning

confidence: 99%

Management of Refractory Diabetic Macular Edema: A Review Article

Torabi

2018

Int J Med Rev

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Diabetic retinopathy (DR) is a major cause of visual impairment worldwide. Visual reduction in patients with DR is usually related to diabetic macular edema (DME). Today, the intravitreal injection of anti-vascular endothelial growth factors (VEGF) is replacing macular laser photocoagulation as the standard treatment for DME; however, in some patients, incomplete responses to the anti-VEGF injection, defined as refractory DME, may occur. Currently, the sequence of using one treatment option and the timing to switch from one agent to another is not fully understood, and the data from clinical trials on the appropriate approach to manage refractory DME is insufficient. In the current study, a review was conducted to evaluate therapeutic options for the management of refractory DME.

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Ranibizumab for Persistent Diabetic Macular Edema after Bevacizumab Treatment

Cited by 21 publications

References 13 publications

Pharmacological Management of Diabetic Macular Edema in Real-Life Observational Studies

Pharmacological Management of Diabetic Macular Edema in Real-Life Observational Studies

Diabetic Macular Edema: Emerging Strategies and Treatment Algorithms

Management of Refractory Diabetic Macular Edema: A Review Article

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