Anti-VEGF Therapy for the Management of Diabetic Macular Edema

Abstract

To review the medical evidence for the use of intravitreal vascular endothelial growth factor (VEGF) inhibitors for the treatment of diabetic macular edema (DME). Evaluation of randomized clinical trials evaluating VEGF inhibitors for center-involved DME. Ranibizumab, an anti-VEGF antibody fragment, was evaluated in two phase III clinical studies entitled RISE and RIDE. At 24 months, significantly more ranibizumab treated patients gained ≥15 letters in vision as compared to the sham group (44.8 and 39.2 % vs. 18.1 %; P < 0.0001). The ranibizumab group improved a mean of 250.6–270.7 µm in central foveal thickness compared to a mean improvement of 125.8–133.4 µm for the sham group. In addition, ranibizumab treated patients were more likely to have improvement in retinopathy. Additional clinical trials have evaluated bevacizumab, another anti-VEGF antibody fragment, and aflibercept, a fusion protein that blocks VEGF. Both bevacizumab and aflibercept have also resulted in superior visual acuity outcomes compared to focal laser photocoagulation. All three agents appear to be safe though these clinical trials were not powered to evaluate safety as a primary outcome. Recent clinical trials have demonstrated the superior outcomes with anti-VEGF agents compared to laser alone or sham treatment. Bevacizumab, ranibizumab and aflibercept have all shown remarkable improvements in both visual acuity outcomes and retinal thickness reductions.