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    Lower treatment burden with earlier administration of anti-VEGF therapy for DME

    Earlier treatment of patients may results in the need for fewer injections over the long term

    Take-home: Earlier treatment of patients with DME who have had visual acuity loss results in the need for fewer intravitreal injections of ranibizumab over the long term.

    Houston—Early administration of anti-vascular endothelial growth factor (VEGF) treatment, specifically ranibizumab (Lucentis, Genentech), in patients with diabetic macular edema (DME) and decreased visual acuity (VA) was shown to be beneficial in this population. Early initial intervention with ranibizumab showed that these patients who had better baseline VA responded well to treatment and needed fewer intravitreal injections over the long term.

    This was an important finding of the RIDE/RISE open-label extension trial. The authors, led by Charles Wykoff, MD, PhD, reported their results in Ophthalmology (2016;123:1716–1721).

    Identifying clinical markers is important because they may allow some degree of prognostication for the patients’ clinical course and treatment burden, according to Dr. Wykoff.

    “The objective of this analysis was to characterize those patients who required less re-treatment during the open-label extension (OLE),” the authors commented.

    The 500 patients included in the OLE were participants in the RIDE/RISE studies. The patients randomized to sham treatment in the RIDE/RISE studies began to receive monthly 0.5-mg injections of ranibizumab at month 25 and those who initially were randomized to ranibizumab continued to receive either 0.3- or 0.5-mg injections of ranibizumab as originally assigned out to 36 months. Upon entering into the OLE, all patients could receive as-needed injections of 0.5-mg of ranibizumab when DME was detected on optical coherence tomography (OCT) images or when there was a decrease in the best-corrected VA (BCVA) of five or more Early Treatment of Diabetic Retinopathy Study letters.

    During the OLE portion of the study, the authors evaluated the effect of the patients’ baseline data, disease characteristics, and treatment response to ranibizumab during the RIDE/RISE studies in an effort to predict how frequently patients with DME would need long-term treatment.

    Dr. Wykoff, who is in private practice in Houston, reported about half of the patients required no or fewer than four annualized injections (121 required zero; 132 required one to three). Of the remainder of the patients, 159 required four to seven annualized injections and 88 needed more than seven annualized injections.

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