In a nutshell
This study compared the use of aflibercept (Eylea) with laser therapy for the treatment of proliferative diabetic retinopathy (PDR). This study determined that aflibercept may be a suitable alternative to laser therapy.
Some background
PDR is the most common cause of severe visual loss in people with diabetes. In PDR blood vessels in the retina (part of the eye) become damaged, may become leaky, and increase in number. Laser has been the standard treatment for PDR. Due to the side effects of laser treatments (such as scarring), other therapies have been investigated.
Recently, treatments that inhibit vascular endothelial growth factor (VEGF), a protein that encourages blood vessel formation, have been found to be useful in treating PDR. They are injected into the back of the eye (intravitreal administration). Aflibercept is the latest VEGF-inhibitor. Research examining the use of aflibercept in PDR is limited.
Methods & findings
232 patients with type 1 or type 2 diabetes and PDR were recruited. They were randomly divided into two groups. One group received intravitreal aflibercept, the other received laser therapy. The aflibercept group was given injections at the start of the study, then after 4 weeks and 8 weeks. After week 12 they were reviewed every 4 weeks and given further injections as needed. The laser group was treated at the start and then every 2 weeks. After week 12 they were followed up every 8 weeks. Best corrected visual acuity (BCVA; a measure of vision function) was measured at 12 weeks and 52 weeks. Questionnaires were given to all participants to assess their quality of life.
After 52 weeks patients treated with aflibercept showed a greater improvement in BCVA than patients treated with laser. Severe loss of visual acuity was more common in the laser group (15%) than the aflibercept group (5%).
18% of people in the laser group experienced a vitreous hemorrhage (bleeding in a part of the eye), compared to 9% of the aflibercept group. Otherwise, side effects were similar between the two groups.
Major differences in the quality of life between the two groups were not found. However, patients who received aflibercept tended to be more satisfied with their treatment than patients in the laser group.
The bottom line
The study concluded that aflibercept may be a useful alternative to laser, due to improved BCVA and fewer side effects.
The fine print
The authors of this study had financial and professional ties to the manufacturers of aflibercept. Aflibercept is a relatively new drug for PDR, and may require more long-term studies to prove its benefits.
What’s next?
Discuss the use of aflibercept and other VEGF-inhibitors with your physician if you experience PDR.
Published By :
Lancet (London, England)
Date :
May 05, 2017
