The anti-vascular endothelial growth factor (VEGF) drug aflibercept significantly reduces leakage associated with proliferative diabetic retinopathy (PDR), according to a new longitudinal study published in Retina. The study demonstrates effectiveness up to 1 year and adds that researchers found monthly dosing more effective than quarterly dosing. 

Instances of diabetic retinopathy are projected to nearly double by 2050. In some cases, it will progress into proliferative diabetic retinopathy (PDR) with the appearance of clinically significant neovascularization, at which point ophthalmologic intervention is often required to halt the development of neovascularization, and subsequent leakage, in the retina. 

That intervention can include various anti-VEGF agents which, research shows, can effectively reduce the progression to PDR for some patients.

The Retina study reviewed data from 40 patients with a mean age of 48 who had been diagnosed with PDR and had a best-corrected visual acuity of 20/400 or worse. The investigators based their findings on a review of retinal leakage as portrayed in ultra-wide field fluorescein angiography (UWFA) imaging.


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The patients were divided into 2 groups. The first group was given a 2 mg intravitreal injection of aflibercept once every 4 weeks, and the second group was given 2 mg intravitreal injection of aflibercept once every 12 weeks. Retinal leakage was measured on UWFA at baseline, as well as at 24 and 48 weeks after injection.

Median leakage at baseline for the 4-week group was 5.1% and, for the 12-week group, 4.3%. By week 24, the 12-week group demonstrated nonsignificant improvements to 3.4% (P =.47). However, the 4-week group significantly improved to 1.1% in that time. At week 48, the 12-week group’s improvement was significant at 1.4% leakage.

The results further confirm the efficacy of aflibercept to reduce leakage due to PDR and demonstrate that monthly dosing of aflibercept leads to faster improvement than quarterly dosing in PDR patients- a finding that may help guide future treatment decisions.  

Subjects who had undergone prior anti-VEGF treatment, vitreoretinal surgery, panretinal photocoagulation, or had significantly relevant diabetic macular edema, or who had a retinal thickness greater than 320 mm were excluded from the study. The investigators noted the relatively small number of subjects in the study, errors that occur with image grading, differing image qualities and image-centering errors as limitations.

Reference

Babiuch A, Wykoff C, Srivastava S, et al. Retinal leakage index dynamics on ultra-widefield fluorescein angiography in eyes treated with intravitreal aflibercept for proliferative diabetic retinopathy in the recovery studyRetina. 2020;40(11):2175-2183. doi:10.1097/IAE.0000000000002727