Author:
Gurung Rajya L,FitzGerald Liesel M,Liu Ebony,McComish Bennet J,Kaidonis Georgia,Ridge Bronwyn,Hewitt Alex W,Vote Brendan J,Verma Nitin,Craig Jamie E,Burdon Kathryn P
Abstract
Abstract
Background
Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections are the standard of care for diabetic macular edema (DME), a common complication of diabetes. This study aimed to identify factors influencing DME intravitreal anti-VEGF treatment outcomes in real-world practice.
Methods
This was a multi-center retrospective observational study using medical chart review of participants receiving anti-VEGF injections for DME (N = 248). Demographic and clinical variables were assessed for association with best corrected visual acuity (BCVA) and central macular thickness (CMT) outcomes using regression models.
Results
There was a significant improvement in BCVA (p < 0.001) and CMT (p < 0.001) after 12 months of treatment, although 21% of participants had decreased BCVA, and 41% had a < 10% CMT reduction at 12 months. Higher baseline BCVA (p = 0.022, OR=-0.024, 95% CI=-0.046,-0.004) and longer duration of diabetic retinopathy (p = 0.048, OR=-0.064, 95% CI=-0.129,-0.001) were negative predictors for BCVA response, whereas Aflibercept treatment (p = 0.017, OR = 1.107, 95% CI = 0.220,2.051) compared with other drugs and a positive “early functional response” (p < 0.001, OR=-1.393, 95% CI=-1.946,-0.857) were positive predictors. A higher baseline CMT (p < 0.001, OR = 0.019, 95% CI = 0.012,0.0261) and an “early anatomical response”, (p < 0.001, OR=-1.677, 95% CI=-2.456, -0.943) were predictors for greater reduction in CMT. Overall, the variables could predict only 23% of BCVA and 52% of CMT response.
Conclusions
The study shows a significant proportion of DME patients do not respond to anti-VEGF therapy and identifies several clinical predictors for treatment outcomes.
Trial registration
The study was approved through the Human Research Ethics Committee, University of Tasmania (approval number H0012902), and the Southern Adelaide Clinical Human Research Ethics Committee (approval number 86 − 067).
Funder
Tasmanian Community Fund
National Health and Medical Research Council (NHMRC) Australia Centre for Research Excellence
Royal Hobart Hospital Research Foundation
Diabetes Tasmania Post graduate research scholarship
Patricia F Gordon Top Up Scholarship
Gerald Harvey Senior Research Fellowship
Williams Oncology Royal Hobart Hospital Research Foundation Grant
Publisher
Springer Science and Business Media LLC