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    5 observations about corticosteroids for DME treatment


    Anti-inflammatory activity

    Findings from many studies show that the pathophysiology of diabetic retinopathy and DME is multifactorial and involves an inflammatory response in addition to VEGF activity.

    “Therefore, controlling the inflammatory component of DME can potentially augment the treatment approach for patients,” Dr. Singh said.

    Evidence of the benefit of intravitreal corticosteroid treatment for decreasing inflammatory factors in eyes with DME is available from a study by Sohn et al. [Am J Ophthalmol. 2011;152(4):686-694] in which patients had fellow eyes randomized to intravitreal treatment with triamcinolone acetonide or bevacizumab (Avastin, Genentech). Bevacizumab was associated with a significant reduction in VEGF levels only whereas VEGF levels and inflammatory cytokines were significantly reduced in the triamcinolone-treated eyes.

    Visual acuity improvement

    Dr. Singh discussed the functional benefit of corticosteroid treatment for DME based on visual acuity area under the curve (AUC) data. He explained that this parameter, which captures medication benefit over an entire observation period, has greater relevance than single visual acuity measurements considering the prolonged duration of treatment for DME.

    Citing data from the pivotal studies (FAME) evaluating the fluocinolone acetonide implant 0.19 mg (Iluvien, Alimera Sciences) and for patients who received ranibizumab (Lucentis, Genentech) plus deferred laser in DRCR.net Protocol I, Dr. Singh showed that the visual acuity AUCs over the 2-year period post randomization were comparable for the corticosteroid and anti-VEGF therapy groups.

    “The lack of difference between groups was particularly apparent when looking at the population of pseudophakic eyes not susceptible to corticosteroid-induced cataract,” Dr. Singh said.

    Disease modification, other benefits


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