Anti-VEGF Therapy Before Steroids for Retinal Vein Occlusion

Laird Harrison

September 20, 2015

NICE, France — Aflibercept and ranibizumab are safer than dexamethasone intravitreal implants for the treatment of central retinal vein occlusion, a new study shows.

"We're very excited about the potential for this new work to help us formulate a plan for managing this condition," said Bejal Udani Shah, MBBS, from Moorfields Eye Hospital in London, United Kingdom.

"Hopefully, these data will help us update the guidelines," she told Medscape Medical News.

Dr Shah presented the findings here at the European Society of Retina Specialists 15th EURETINA Congress.

The incidence of central retinal vein occlusion ranges from about 0.5% to 0.8%.

Both steroidal and anti-vascular endothelial growth-factor (VEGF) treatments have been shown to be effective, but "there is no current consensus as to which agent you should be using first line, and no head-to-head trials," Dr Shah explained.

She and her colleagues chose to compare aflibercept, ranibizumab, and dexamethasone because they are the only treatments approved for this condition in the United Kingdom, the United States, and many other countries.

The researchers retrospectively compared 30 treatment-naive patients who attended the clinic over a 2-year period. Ten patients were treated with 2.5 mg, 10 were treated with ranibizumab 0.5 mg, and 10 were treated with a dexamethasone implant 0.7 mg.

All three drugs reduced central retinal thickness, but the reduction was significant only with aflibercept and dexamethasone (P < .05), Dr Shah reported.

Although patients in the ranibizumab group experienced a mean improvement in logMAR visual acuity, the change was not significant (P = .06).

There were no reported adverse events in the anti-VEGF groups, but three of the 10 patients in the dexamethasone group experienced an increase in intraocular pressure.

"From the preliminary results we do have, there seems to be a suggestion that the anti-VEGFs should be first line, if, of course, there are no contraindications," she said. "That is actually what we practice in our department, where we recommend the use of either of the two anti-VEGFs in preference to dexamethasone because of the documented side-effect profile of it."

Dr Shah acknowledged that the study population is very small. When asked by a member of the audience whether her team has planned a prospective study, she responded by explaining that, "at the moment, we're increasing the retrospective population we have, but we're also looking at our ongoing patients."

Another audience member noted that previous trials have shown that dexamethasone intravitreal implants are not as effective as aflibercept or ranibizumab after 3 months.

Most clinicians already use anti-VEGF treatments as their first-line option for central retinal vein occlusion, said Athanasios Nikolakopoulos, MD, from George Papanikolaou Hospital in Thessaloniki, Greece.

"Start out with anti-VEGF," he told Medscape Medical News. "If it's refractive, you might go to dexamethasone."

But he pointed out that steroids still have potential for treating retinal vein occlusion. "Everyone is trying to find a cortisone without raising the pressure," he said.

Dr Shah and Dr Nikolakopoulos have disclosed no relevant financial relationships.

European Society of Retina Specialists 15th EURETINA Congress. Presented September 20, 2015.

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