Real World Use of Aflibercept in the Treatment of Diabetic Macular Oedema

Michael Williams, Orla McNally

Research output: Contribution to conferencePosterpeer-review

Abstract

Purpose.
High quality evidence on the efficacy of aflibercept for diabetic macular oedema (DMO) has come from clinical trials. This study aims to examine the visual and anatomic outcomes in the real world, outside the setting of a trial, using a retrospective electronic case note review.

Methods
A consecutive series of patients attending a Macular Clinic in the UK during a predefined time-period were selected who had had at least three intravitreal injections of aflibercept for DMO. Best corrected visual acuity (BCVA) was recoreded, and the optical coherence tomographic (OCT) parameters of central retinal thickness (CRT) and macular volume (MV) on Spectralis OCT maps (Heidelberg).

Results.
Twenty-six eyes of 18 patients (14 males, all with type II DM) had had no prior intravitreal injections. The mean age was 63.8 years (s.d. 8.1). The mean number of injections received per eye was 5.9 (s.d. 2.1, range 3 to 10, with 12/26 having had 3-5 injections only), over a mean time of 37.3 weeks (s.d. 9.3, range 10 to 56).
With aflibercept, 18/26 eyes (69.2%) had improved BCVA, 1/26 (3.9%) had no change and 7/26 (26.9%) had worsening (mean BCVA change +6 letters, s.d. 14.6, range -37 to +39). Reduction in each of CRT and MV occurred in 24/26 eyes (92.3%) (mean CRT change -112.4 μm, s.d. 93.7, range -389 to +89; mean MV change -0.9 mm3, s.d. 0.9, range -3.3 to +0.6).
Thirty-six eyes of 21 patients (13 males, 13 with type II DM) had been switched from ranibizumab to aflibercept. Their mean age was 61.8 years (s.d. 15.7), and mean duration since DM diagnosis of 18.9 years (s.d. 12.2). A mean of 11.9 (s.d. 5.0, range 1 to 20) injections were given prior to commencing aflibercept. Reasons for switching were poor response to ranibizumab (17 patients), recurrence of macular oedema within 4 weeks (3 patients) and an inflammatory reaction to ranibizumab (1 patient). The mean number of aflibercept injections received was 5.8 (s.d. 2.0, range 3 to 9, with 17/36 eyes having had 3-5 injections only) over a mean of 41.1 weeks (s.d. 9.9, range 20 to 54). After switching, improvement in BCVA occurred in 24/36 (66.7%), 5/36 (13.9%) had no change and worsening of BCVA occurred in 7/36 eyes (19.4%), (mean improvement 3.1 letters, s.d. 7.3, range -14 to +35). CRT and MV each reduced in 24/36 eyes (66.7%) (mean CRT reduction -46.5μm, s.d. 127.8, range -435 to 368; mean MV reduction -0.6, s.d. +1.0, range -3.6 to +0.9).

Conclusions.
These results are encouraging given variation within the sample in injection number, the mean injection frequency of 6-7 weekly and the nature of the real world in which ocular co-morbidities are seen, which would preclude entry into trials. Further work is needed with bigger samples, and to explore what factors are associated with lack of success.
Original languageEnglish
Publication statusPublished - 05 May 2017
EventARVO ( the Association for Research in Vision and Ophthalmology) 2017 Annual Meeting -
Duration: 04 May 2017 → …

Conference

ConferenceARVO ( the Association for Research in Vision and Ophthalmology) 2017 Annual Meeting
Period04/05/2017 → …

Bibliographical note

I did not attend this conference: my colleague and coauthor, Ms McNally, presented the poster.

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