scholarly journals miRNA Levels as a Biomarker for Anti-VEGF Response in Patients with Diabetic Macular Edema

2021 ◽  
Vol 11 (12) ◽  
pp. 1297
Author(s):  
Maartje J. C. Vader ◽  
Yasmin I. Habani ◽  
Reinier O. Schlingemann ◽  
Ingeborg Klaassen
Keyword(s):  
Regression Analysis ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Linear Regression Analysis ◽  
Central Area ◽  
Comparative Trial ◽  
Predictive Biomarker ◽  
Negatively Associated ◽  
Anti Vegf ◽  
Endothelial Growth Factor

Background: The aim of this study was to investigate whether miRNA levels in the circulation could serve as a predictive biomarker for responsiveness to anti-vascular endothelial growth factor (VEGF) therapy in patients with diabetic macular edema. Methods: Whole blood samples were collected at baseline from 135 patients who were included in the BRDME study, a randomized controlled comparative trial of monthly bevacizumab or ranibizumab treatment for 6 months in patients with diabetic macular edema (Trialregister.nl, NTR3247). Best corrected visual acuity letter score (BCVA) and retinal central area thickness (CAT) were measured monthly during the 6-month follow-up. Levels of selected miRNAs were quantified. Results: Following linear regression analysis, the levels of four miRNAs were negatively associated with baseline CAT. Multivariable regression analysis confirmed this association for miR-181a. No associations with changes in CAT after 3 or 6 months of anti-VEGF treatment were found. In addition, no associations with miRNA levels with baseline BCVA or change in BCVA after 3 or 6 months of anti-VEGF treatment were found. Conclusions: Circulating miR-181a levels were negatively associated with CAT at baseline. However, no associations between miRNA levels and the response to anti-VEGF therapy were found.

Evaluation of Patients Receiving Intravitreal Antivascular Endothelial Growth Factor for Diabetic Macular Edema in Clinical Practice in the United States

2020 ◽  
pp. 247412642095306
Author(s):  
John D. Pitcher ◽  
Andrew A. Moshfeghi ◽  
Genevieve Lucas ◽  
Nick Boucher ◽  
Hadi Moini ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Growth Factor ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
The United States ◽  
Treatment Frequency ◽  
Anti Vegf ◽  
Injection Frequency ◽  
Antivascular Endothelial Growth Factor ◽  
Endothelial Growth Factor

Purpose: We assessed the effect of treatment frequency with intravitreal antivascular endothelial growth factor (anti-VEGF) agents on visual acuity (VA) in diabetic macular edema (DME). Methods: This retrospective analysis assessed electronic medical records of eyes newly diagnosed with DME and treated with an anti-VEGF agent at US clinics using the Vestrum Health (Naperville, Illinois) treatment and outcomes database. Eyes were divided into 2 injection frequency subcohorts (≤ 6 vs > 6 injections/y); treatment frequency and change in mean VA (Early Treatment Diabetic Retinopathy Study letters) were evaluated. Results: Among 155 240 eyes assessed, 3028 met inclusion criteria for analysis in year 1 and 1292 in year 2. During year 1 of treatment, 57% (n = 1725) received > 6 injections; most continued to receive the same injection frequency during year 2. Mean VA gain from baseline at year 1 was lower in the ≤ 6 than in the > 6 injections/year subcohort (3.7 vs 8.0 letters, respectively; P < .001). Mean VA change from the end of year 1 to year 2 for eyes receiving ≤ 6 injections in year 1 generally remained unchanged, irrespective of year 2 dosing frequency. In eyes that received > 6 injections in year 1, mean VA loss was significantly greater for eyes receiving less-frequent dosing in year 2 than in those maintained on > 6 injections. Conclusions: More than 50% of eyes with DME in routine clinical practice that completed at least 1 year of follow-up received > 6 injections of an anti-VEGF agent during the first year, resulting in better VA gains than eyes treated less frequently.

scholarly journals EFFECT OF ANTI-VEGF THERAPY ON THE STRUCTURAL STATE OF THE RETINA IN DIABETIC MACULAR EDEMA

2016 ◽  
Vol 1 (6) ◽  
pp. 24-27
Author(s):  
Бикбов ◽  
Mukharram Bikbov ◽  
Файзрахманов ◽  
Rinat Fayzrakhmanov ◽  
Зайнуллин ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Optical Density ◽  
Structural State ◽  
Central Area ◽  
Macular Pigment ◽  
Optical Coherence ◽  
Macular Pigment Optical Density ◽  
Anti Vegf

Objective: to analyze the structural state of the central area of the retina in diabetic macular edema in the background anti-VEGF therapy.Methods. The study included 38patients (40eyes) with diabetic macular edema. All patients received anti-VEGF-ranibizumab therapy at a dose of 0.05ml. The results were analyzed after three intravitreal injections with 1month interval. We assessed visual acuity, morphological and anatomical structure of the macular area, the sensitivity of the retina and macular pigment optical densityResults. Analyzing optical density of the macular pigment we revealed a significant increase of all parameters in 73% of patients after the therapy. The average value of the optical density before treatment was at 0.102±0.01du, on the background of anti-VEGF-therapy this figure went up to 0.213±0.01 (p&#60;0.05). According to the optical coherence to-mography average retinal thickness before treatment made 404.62±15.23μm, after the treatment – 300.91±6.43μm (р&#60;0,05). When comparing data of optical coherence tomography and macular pigment optical density we revealed more pronounced decrease in the macular pigment optical density in the area of the retinal edema and a significant increase in the basic parameters on the background of the therapy.Conclusion. Anti-VEGF-therapy significantly improves visual acuity, the recovery profile of macular edema and reduces the zone in patients with diabetic macular edema.

scholarly journals The Impact of Interval between Recurrence and Reinjection in Anti-VEGF Therapy for Diabetic Macular Edema in Pro Re Nata Regimen

2021 ◽  
Vol 10 (24) ◽  
pp. 5738
Author(s):  
Yoshihiro Takamura ◽  
Teruyo Kida ◽  
Hidetaka Noma ◽  
Makoto Inoue ◽  
Shigeo Yoshida ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Functional Improvement ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Group 3 ◽  
Pro Re Nata ◽  
Endothelial Growth Factor ◽  
The Impact ◽  
Deferred Group

Background: Pro re nata (PRN) regimen using anti-vascular endothelial growth factor (VEGF) agent is popular for the treatment of diabetic macular edema (DME). We investigated the influence of waiting time (WT) and interval between the date of recurrence of edema and re-injection on treatment efficacy. Methods: This retrospective study conducted at 7 sites in Japan enrolled patients who received intravitreal injection of ranibizumab (IVR) and aflibercept (IVA) in 1+PRN regimen. Enrolled patients were divided into 2 groups: prompt group (less than 1 week) and deferred group (3 weeks or more). Central retinal thickness (CRT) and best corrected visual acuity (BCVA) were measured every month for 1 year. Results: CRT in the deferred group was significantly higher than that in the prompt group at 2, 5, 6, 7, and 12 months (p < 0.05). BCVA in the prompt group was significantly better than that in the deferred group at 7, 10, and 12 months (p < 0.05). Conclusion: The prompt group was superior in anatomical and functional improvement of DME in anti-VEGF therapy than the deferred group. Our data suggests that shorter WT is recommended for better visual prognosis in the treatment for DME.

scholarly journals Combination Treatment of Diabetic Macular Edema with Anti-Vascular Endothelial Growth Factor and Steroids: Analysis of DRCR.net Protocol U

2018 ◽  
Vol 1 ◽  
pp. 2
Author(s):  
Cindy Ung ◽  
Kareem Moussa ◽  
Yoshihiro Yonekawa
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Diabetic Patients ◽  
Vascular Endothelial ◽  
First Line ◽  
Second Line Therapy ◽  
Anti Vegf ◽  
Endothelial Growth Factor

Diabetic macular edema (DME) is the main cause of visual impairment in diabetic patients. Intravitreal anti-vascular endothelial growth factor (VEGF) therapy is considered the first-line treatment option in the management of DME with corticosteroids used as second-line therapy. The DRCR.net Protocol U study was a Phase II trial that sought to compare the combination of a steroid and anti-VEGF therapy to anti-VEGF monotherapy regarding visual acuity and anatomic outcomes. This review highlights the strengths, weaknesses, and clinical implications of this study.

scholarly journals Worsening Proteinuria Following Intravitreal Anti-VEGF Therapy for Diabetic Macular Edema

2018 ◽  
Vol 3 (1) ◽  
pp. 54-56 ◽  
Author(s):  
Jessie-Anne Kenworthy ◽  
Justin Davis ◽  
Varun Chandra ◽  
J. Ben Clark ◽  
Michael Desmond
Keyword(s):  
Case Report ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Intravitreal Bevacizumab ◽  
Standard Of Care ◽  
Systemic Effects ◽  
Anti Vegf ◽  
Antivascular Endothelial Growth Factor ◽  
Growing Body ◽  
Endothelial Growth Factor

Intravitreal antivascular endothelial growth factor (anti-VEGF) therapy is a standard of care for a variety of ophthalmological conditions. While the systemic use of these agents in oncology is well known to induce a number of renal-related adverse effects such as worsening hypertension and proteinuria, the ability of local intravitreal injections to cause similar side effects has traditionally been thought to be unlikely given the lower doses used. In this case report, we describe an 88-year-old woman who developed a sudden worsening of her previously stable proteinuria with the use of bilateral intravitreal bevacizumab injections for diabetic macular edema, with improvement in her proteinuria upon reduction to unilateral therapy. This case report adds to the growing body of literature that suggests that local anti-VEGF therapy may have the potential to induce adverse systemic effects, and clinicians who care for these patients should remain vigilant to the development of potential renal-related toxicity.

Aflibercept: A Review of Its Use in the Management of Diabetic Eye Complications

2016 ◽  
Vol 30 (5) ◽  
pp. 534-540 ◽  
Author(s):  
Oluwaranti Akiyode ◽  
Jateh Major ◽  
Abiola Ojo
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Vascular Endothelial ◽  
Efficacy And Safety ◽  
Vegf Inhibitor ◽  
Anti Vegf ◽  
Visual Acuity Loss ◽  
Endothelial Growth Factor

Aflibercept is the most recently approved vascular endothelial growth factor (anti-VEGF) inhibitor for the management of diabetic macular edema and diabetic retinopathy. The purpose of this article is to review the efficacy and safety of aflibercept in the management of diabetic eye complications and to describe its place in therapy. Anti-VEGF agents have been noted in clinical trials to be superior to laser photocoagulation, the standard therapy ( P < .0001, P ≤ .0085, respectively). Aflibercept has been comparatively studied with other anti-VEGF agents, namely, bevacizumab and ranibizumab, and noted to be equally efficacious and safe in patients with mild visual acuity loss ( P > .50). However, in the treatment of patients with diabetic macular edema having moderate to severe visual acuity loss, aflibercept outperformed the other 2 anti-VEGF agents (aflibercept vs bevacizumab, P < .001; aflibercept vs ranibizumab, P = .003). However, additional studies are needed to fully appreciate the long-term safety and efficacy of aflibercept and the anti-VEGF therapy class.

scholarly journals Optical Coherence Tomography Parameters Related to Vision Impairment in Patients with Diabetic Macular Edema: A Quantitative Correlation Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Bing Li ◽  
Bilei Zhang ◽  
Youxin Chen ◽  
Donghui Li
Keyword(s):  
Optical Coherence Tomography ◽  
Regression Analysis ◽  
Linear Regression ◽  
Multiple Linear Regression ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Linear Regression Analysis ◽  
Multiple Linear Regression Analysis ◽  
Vision Impairment ◽  
Optical Coherence

Purpose. To quantitatively explore the correlation between optical coherence tomography (OCT) parameters and vision impairment in patients with diabetic macular edema (DME). Methods. This study was a retrospective observational case series. One-hundred eyes from 66 patients with DME were retrospectively included. OCT parameters, including central macular thickness (CMT), height of intraretinal cystoid, subretinal fluid and sponge-like retinal swelling, density of hyperreflective foci (HRF), and integrity of the ellipsoidal zone (EZ), were assessed. Correlation analyses and multiple linear regression analysis were performed to quantitatively explore the relationship between best-corrected visual acuity (BCVA) and OCT parameters. Results. Among all OCT parameters, CMT, height of intraretinal cystoid, height of sponge-like retinal swelling, and density of HRF and EZ integrity were significantly correlated with BCVA (r = −0.550, −0.526, −0.411, −0.277, and −0.501, respectively; P<0.01). In multiple linear regression analysis, CMT, density of HRF, and EZ integrity fit a significant linear equation (β = 0.482, 0.184, and 0.447, respectively), with the adjusted R square reaching 0.522 (P<0.001). In eyes without SRF, the height of intraretinal cystoid, density of HRF, and EZ integrity were included in the model and an adjusted R square of 0.605 (P<0.001) was obtained. Conclusion. In DME eyes, OCT parameters, including the density of HRF, the EZ integrity together with CMT, or the height of intraretinal cystoid, could explain 52.2% to 60.5% of the variation in BCVA and were weighted approximately 2 : 1 : 2, respectively.

scholarly journals Real-world outcomes following 12 months of intravitreal aflibercept monotherapy in patients with diabetic macular edema in France: results from the APOLLON study

2020 ◽  
Vol 258 (3) ◽  
pp. 521-528 ◽  
Author(s):  
Jean-François Korobelnik ◽  
Vincent Daien ◽  
Céline Faure ◽  
Ramin Tadayoni ◽  
Audrey Giocanti-Auregan ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Treatment Start ◽  
Anti Vegf ◽  
Intravitreal Aflibercept ◽  
Treatment Naïve ◽  
Secondary Endpoints ◽  
Previously Treated Patients ◽  
Previously Treated ◽  
Endothelial Growth Factor

Abstract Purpose To report the effectiveness of intravitreal aflibercept (IVT-AFL) treatment for diabetic macular edema (DME) in French clinical practice. Methods APOLLON (NCT02924311) was a prospective, observational cohort study of patients with DME. Effectiveness was evaluated by change from baseline in best-corrected visual acuity (BCVA) at 12 months in treatment-naïve patients (i.e., had not received any anti-vascular endothelial growth factor [anti-VEGF] agent, laser, or steroid at IVT-AFL treatment start) and previously treated patients (i.e., previously treated with anti-VEGF agents other than IVT-AFL, laser, or steroids at IVT-AFL treatment start). Secondary endpoints included change in central retinal thickness (CRT) over 12 months, frequency of injections, and proportion of patients with safety events. Results Of the 147 patients followed for at least 12 months and included in the effectiveness analysis, 52.4% (n = 77) were treatment-naïve and 47.6% (n = 70) were previously treated. Mean (standard deviation [SD]) BCVA score at baseline was 62.7 (14.3) Early Treatment Diabetic Retinopathy Study (ETDRS) letters in treatment-naïve patients and 60.0 (13.7) ETDRS letters in previously treated patients. At month 12, mean (SD) change in BCVA was + 7.8 (12.3) letters in treatment-naïve patients and + 5.0 (11.3) letters in previously treated patients. Mean CRT decreased in both patient cohorts. The mean (SD) number of IVT-AFL injections at month 12 was 7.6 (2.5) for treatment-naïve patients and 7.6 (2.3) for previously treated patients. Of 388 patients included in the safety analysis, ocular treatment-emergent adverse events occurred in 54.1% (n = 210) of patients. Conclusion IVT-AFL treatment was associated with improvements in functional and anatomic outcomes in both treatment-naïve and previously treated patients with DME in France.

Comparative Eye Effect of Unilateral Intravitreal Bevacizumab, Ranibizumab, and Aflibercept for Diabetic Macular Edema

2019 ◽  
Vol 3 (2) ◽  
pp. 86-89
Author(s):  
Brett Malbin ◽  
Harshad P. Patel ◽  
Yuguang He ◽  
Kim Le ◽  
Xihui Lin
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Intravitreal Bevacizumab ◽  
Fellow Eye ◽  
Anti Vegf ◽  
Central Subfield Thickness ◽  
Bilateral Diabetic Macular Edema ◽  
Pharmacologic Treatments ◽  
Endothelial Growth Factor ◽  
Significant Therapeutic Effect

Purpose: The purpose of this article is to compare the fellow-eye effect of unilateral intravitreal antivascular endothelial growth factor (anti-VEGF) treatment (bevacizumab, ranibizumab, and aflibercept) in patients with bilateral diabetic macular edema (DME). Methods: A retrospective review was conducted of hemoglobin A1c-matched groups receiving unilateral anti-VEGF injections (1.25 mg bevacizumab, 0.5 mg ranibizumab, and 2 mg aflibercept) in which the second eye had subclinical DME. Two main outcome measures evaluated were central subfield thickness (CST) on optical coherence tomography and best-corrected visual acuity (BCVA). Patients were excluded if they had poor BCVA (< 20/100) or had received laser, vitrectomy, filtering surgery, or pharmacologic treatments in the 3 months prior in the noninjected eye. Results: A total of 2073 total intravitreal anti-VEGF injections for DME were reviewed and 94 met the inclusion criteria: 40 bevacizumab, 33 ranibizumab, and 21 aflibercept. At 1 month, the CST of the fellow eye in the bevacizumab group had a statistically significant decrease (296.82 µm to 292.46 µm, P = .01) while both the ranibizumab and aflibercept groups trended toward worsening edema. When compared to ranibizumab and aflibercept, the CST in the noninjected eye in the bevacizumab group had improvements of –15.03 µm and –13.47 µm, respectively ( P < .019). When bevacizumab was switched to ranibizumab or aflibercept, the edema in the fellow eye worsened by +49.60 µm and +5.50 µm, respectively. Conclusion: Bevacizumab injection has a statistically significant therapeutic effect in the fellow eye when compared to those treated with ranibizumab and aflibercept. The edema in the fellow eye worsened when injection in the primary eye was switched away from bevacizumab.

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