EFFICACY, SAFETY, AND LONG-TERM OUTCOMES OF ANTI-VEGF THERAPY IN DIABETIC RETINOPATHY
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Keywords
Diabetic retinopathy, diabetic macular edema, anti-VEGF therapy, long-term outcomes, efficacy, safety, intravitreal
Abstract
Background: Diabetic retinopathy (DR) and diabetic macular edema (DME) are the leading causes of vision impairment for people around the globe. Due to its potential to inhibit underlying angiogenesis and edema, anti-VEGF therapies have become cornerstones for the management of DR and DME. However, for optimal treatment strategies it is critical to understand patient outcome and the long term efficacy and safety of treatments.
Objectives: With a focus on clinical trials, real world studies and patient perspectives, this review is intended to assess the efficacy, safety and long term outcomes of anti VEGF therapy for diabetic retinopathy.
Methodology: PubMed, Scopus and Google Scholar were searched extensively to identify clinical trials, meta-analyses and observational studies published between 2010 and 2023. The terms used as keywords were "anti-VEGF therapy," "diabetic retinopathy," "diabetic macular edema," "long term outcomes," and "safety." Included studies addressing ranibizumab, aflibercept, bevacizumab and conbercept in different DR stages. Visual outcomes, recurrence rates, safety profiles and patient compliance were synthesized.
Results: Efficacy of anti-VEGF agents in visual acuity, central macular thickness reduction in DR, and DME is significant. Long term data from the RISE, RIDE, RESTORE and Protocol T trials confirm that consistent therapy can prevent disease progression and improve visual outcomes. Personalized treatment intervals show real world study benefits for patient adherence. Low systemic complication rates were found but there was concern of ocular side effects such as inflammation or elevated intraocular pressure that should be monitored. Robust efficacy notwithstanding, weaknesses such as injection burden and cost call for patient specific strategies.
Conclusion: Long-term follow ups on anti VEFG therapy remains highly effective and safe treatment option for DR and DME, which is also able to arrest vision loss and disease progress. However, despite that, patient adherence, cost issues and attending to disparities in global accessibility continue to be fundamental in maximizing therapeutic outcomes.
References
2. Ehlers, J. P., Goel, N., & Singh, R. P. (2014). Ocular anti-VEGF therapy for diabetic retinopathy: Overview of clinical efficacy and safety. Diabetes Care, 37(4), 900–907. Retrieved from https://diabetesjournals.org/care/article/37/4/900/31838/Ocular-Anti-VEGF-Therapy-for-Diabetic-Retinopathy
3. Grzybowski, A., Patryn, K., Ascaso, F. J., &Huerva, V. (2023). Update on the management of diabetic retinopathy: Anti-VEGF agents and ocular drug delivery systems. Life, 13(5), 1098. Retrieved from https://www.mdpi.com/2075-1729/13/5/1098
4. Heier, J. S., Brown, D. M., Chong, V., et al. (2016). Systemic safety of prolonged monthly anti–vascular endothelial growth factor therapy. JAMA Ophthalmology, 134(1), 21–29. Retrieved from https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2465309
5. Nguyen, Q. D., Brown, D. M., Marcus, D. M., et al. (2012). Ranibizumab for diabetic macular edema: Results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology, 119(4), 789–801.
6. Wells, J. A., Glassman, A. R., Ayala, A. R., et al. (2015). Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. New England Journal of Medicine, 372(13), 1193–1203.
7. Writing Committee for the Diabetic Retinopathy Clinical Research Network, Gross, J. G., Glassman, A. R., et al. (2015). Panretinal photocoagulation vs intravitreousranibizumab for proliferative diabetic retinopathy: A randomized clinical trial. JAMA, 314(20), 2137–2146.
8. Wykoff, C. C., & Clark, W. L. (2022). Efficacy and safety of intravitreal anti-VEGF therapy in diabetic retinopathy. Expert Opinion on Drug Safety, 21(8), 987–995. Retrieved from https://pubmed.ncbi.nlm.nih.gov/35818801/
9. Zhang, X., &Saaddine, J. (2022). Long-term efficacy of intravitreal anti-VEGF in preventing progression of diabetic retinopathy. Ophthalmic Research, 70(5), 10–18.
10. Retina Today Editorial Team. (2021). Long-term outcomes of anti-VEGF therapy. Retina Today. Retrieved from https://retinatoday.com/articles/2021-nov-dec/long-term-outcomes-of-anti-vegf-therapy
11. Nguyen, Q. D., Brown, D. M., Marcus, D. M., et al. (2023). The long-term impact of anti-VEGF therapy for diabetic macular edema. Retina Specialist. Retrieved from https://www.retina-specialist.com/article/the-longterm-impact-of-antivegf-therapy-for-dme
12. Do, D. V., Nguyen, Q. D., Boyer, D., et al. (2012). One-year outcomes of the DA VINCI study of VEGF Trap-Eye in diabetic macular edema. Ophthalmology, 119(8), 1658–1665.
13. Elman, M. J., Ayala, A., Bressler, N. M., et al. (2010). Intravitrealranibizumab for diabetic macular edema with prompt versus deferred laser treatment: Three-year randomized trial results. Ophthalmology, 117(6), 1064–1077.e35.
14. Mitchell, P., Bandello, F., Schmidt-Erfurth, U., et al. (2011). The RESTORE study: Ranibizumab monotherapy or combined with laser versus laser monotherapy for diabetic macular edema. Ophthalmology, 118(4), 615–625.
15. Bressler, S. B., Beaulieu, W. T., Glassman, A. R., et al. (2018). Persistent macular thickening after ranibizumab treatment for diabetic macular edema with vision impairment. JAMA Ophthalmology, 136(3), 257–269.
16. Ip, M. S., Domalpally, A., Hopkins, J. J., et al. (2012). Long-term effects of ranibizumab on diabetic retinopathy severity and progression. Archives of Ophthalmology, 130(9), 1145–1152.
17. Korobelnik, J. F., Do, D. V., Schmidt-Erfurth, U., et al. (2014). Intravitrealaflibercept for diabetic macular edema. Ophthalmology, 121(11), 2247–2254.
18. Lang, G. E., Berta, A., Eldem, B. M., et al. (2013). Two-year safety and efficacy of ranibizumab 0.5 mg for diabetic macular edema: The RESTORE study. Ophthalmology, 120(9), 1790-1799. https://doi.org/10.1016/j.ophtha.2013.02.023
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Khadiga Abayazeed Hassan Ahmed
Sudan International University, Sudan
Asma Muhumed Hussein
Tbilisi State Medical University, Georgia, Tbilisi
Amirah Yassin Saeed
Caucasus International University, Tbilisi, Georgia
May Macky
HMS Mirdif Private Hospital, Dubai, UAE
Abdulrahman Al Qaderi
Medical Intern, RAKMHSU, UAE
Rana Anees Ur Rehman
Shifa International Hospital, Islamabad, Pakistan
Nour Al Qaderi
Medical Intern at Ajman University, Ajman, UAE
Raniah Albairmani
HMS Al Garhoud Private Hospital, Dubai, UAE
Sidra Hariss
Intern Doctor at Gulf Medical University, UAE
Maha Hasan Nasser Salem
Medical Intern at Medcare Hospital, UAE
Goutam Kewalramani
St. George’s School of Medicine, Newcastle, UK