DME: Early Response to Anti-VEGF Therapy Predicts Outcome

Jennifer Garcia

February 24, 2017

Early response to treatment with anti–vascular endothelial growth factor (VEGF) agents may predict long-term outcomes among patients with diabetic macular edema (DME), a small study suggests.

"Our analysis found if the treated patient had a >15% reduction in CRT [corneal retinal thickness] at 1 month, they would often go on to have a 25% reduction at 3 months (sensitivity, 0.75; specificity, 0.92; positive predictive value, 0.86; negative predictive value, 0.85)," write Jeremy D. Wolfe, MD, MS, from the Oakland University William Beaumont School of Medicine and Associated Retinal Consultants, Royal Oak, Michigan, and colleagues.

Dr Wolfe and colleagues reported the results of their study in an article published online February 1 in the Journal of VitreoRetinal Diseases.

The researchers retrospectively evaluated data from 34 patients (40 eyes) with DME seen between June 2011 and June 2014. Patients were 18 years of age or older, had no previous DME therapy or no therapy for the prior 3 months, and must have received at least three consecutive monthly anti-VEGF injections with the same agent.

The researchers evaluated Snellen best-corrected visual acuity and CRT at baseline and again at 1, 2, 3, 6, and 12 months. Anti-VEGF responders were defined as those with a greater than 25% reduction in CRT at 3 months.

The researchers found improvements in best-corrected visual acuity after the first month of therapy, decreasing from an average of 0.60 ± 0.37 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.53 ± 0.36 logMAR (P = .03). Improvements continued at the 3-month check (0.47 ± 0.42 logMAR; P = .01) and at 12 months (0.40 ± 0.33 logMAR; P < .001).

Further, CRT decreased at all times measured: 434.58 ± 176.94 μm at baseline to 389.00 ± 153.31 μm at 1 month (P = .012), 352.75 ± 152.36 μm at 3 months (P < .001), and 324.18 ± 136.53 μm at 12 months (P < .001).

Further analysis demonstrated that a cutoff of a greater than 15% reduction in CRT at 1 month predicted anti-VEGF response at 3 months based on the receiver-operating characteristic curve analysis. "Moreover, the AUC [area under the curve] measure of 0.83 ± 0.76 was significantly greater than chance (95% CI [confidence interval], 0.68-0.97; P < .001) and considered in the 'excellent' diagnostic range," the study authors note.

The researchers underscore the fact that identifying early responders would help the clinician decide whether to continue the same anti-VEGF agent or switch to alternative therapies, and that the assessments used in the current analysis do not require additional intervention beyond common current practice patterns.

The authors acknowledge that, in addition to the small sample size and the limitations of retrospective data, there was selection bias in the study design in that only patients with severe DME were included and not all patients were treatment-naive.

Dr Wolfe and colleagues conclude, however, that "[t]his approach is readily available, cheap, and noninvasive and can be combined with other measurable parameters to drive complex management of patients with DME."

The authors have disclosed no relevant financial relationships.

J Vitreoretin Dis. Published online Februrary 1, 2017. Abstract

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