Less may be more in a real-world study of anti-VEGF therapy for DME

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Extended treatment intervals of anti-vascular endothelial growth factor (VEGF) injections in patients with diabetic macular edema (DME) in a real-world setting seemed to preserve vision in patients with good baseline best visual acuities (BVAs),¹ Carter J. Payne, MD, and colleagues reported. He is the study first author from Case Western Reserve University School of Medicine, Cleveland.

In clinical trials, patients are treated according to strict protocols, but in the real world, strict adherence to an injection frequency is difficult because of the economic burden associated with repeated injections. The result may be that patients do not receive enough treatment compared to what happens in clinical trials, the authors explained.

The primary aim of the study under discussion was to determine the real-world anti-VEGF treatment pattern. The authors looked at the mean number of injections, injection type, and injection interval at 12 and 24 months from the index date, they explained.

The secondary aims were to compare changes in the BVAs and central subfield thickness (CST) in patients with DME treated with varying intervals of anti-VEGF injection frequency, assess what real-world factors are related to changes in the BVA, and assess the relationship between patient medical and demographic factors and anti-VEGF injection intervals.

The investigators conducted a non-randomized retrospective cohort study that included 291 patients with DME who received anti-VEGF injections from January 1, 2012, to December 31, 2019, at the Cole Eye Institute, Cleveland. The study compared the 12- and 24-month BVAs and CSTs between injection interval groups, which were determined by averaging the 2 most recent injection intervals.

The following injection frequency intervals and patient percentages were found: 48.8% of patients were treated every 8 or fewer weeks, 27.5% were treated between every 8 to 12 week, and 23.7% were treated longer than every 12 weeks. The investigators reported that the patient baseline CSTs were similar (p = 0.32) among the groups. However, the BVA differed significantly in the patients who were treated every 8 to 12 weeks (p = 0.0095).

At the 12-month time point, the BVAs and CSTs were similar, but the patients treated from 8 to 12 weeks had greater 12-month improvements in the BVA (7.36 ± 12.4 letters) compared with those treated at intervals exceeding 12 weeks (1.26 ± 12.3 letters; p = 0.0056). At the 24-month time point, changes in the BVAs and CSTs were similar between the groups (p = 0.30 and p = 0.87).

The data showed that the baseline BVA, hemoglobin A1c, and sex were associated with the 12-month BVA, and the baseline BVA and CST were associated with the 12-month CST.

The authors concluded, “Many patients experienced improvements in the BVA and CST over 12 months of treatment despite receiving less frequent anti-VEGF therapy than recommended in the pivotal trials. The present study showed that extended treatment intervals with bevacizumab (Avastin, Genentech) preserved the vision of many individuals with high baseline BVA.

Reference

1. Payne CJ, Gupta U, Maatouk CM, et al. Real-world effects of anti-vascular endothelial growth factor injection frequency on visual outcomes in patients with diabetic macular oedema. Eye. 2024; https://doi.org/10.1038/s41433-024-02998-2