DEFINING "STRONG" VERSUS "WEAK" RESPONSE TO ANTIVASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENT FOR CENTER-INVOLVED DIABETIC MACULAR EDEMA. Issue 4 (April 2023)

• Record Type: Journal Article
• Authors: Sun, Jennifer K.; Beaulieu, Wesley T.; Melia, Michele; Ferris, Frederick L.; Maturi, Raj K.; Nielsen, Jared S.; Solomon, Sharon D.; Jampol, Lee M.
• Is Part Of: Retina. Volume 43:Issue 4(2023)
• Page Start: 616
• Page End: 623
• Publication Date: 2023-04
• Subjects: antivascular endothelial growth factor -- diabetic macular edema -- phenotypes; Retina -- Diseases -- Periodicals; Retinal Diseases; Vitreous Body; 617.735
• DOI: 10.1097/IAE.0000000000003730
• Languages: English
• ISSNs: 0275-004X

Abstract

Abstract : Supplemental Digital Content is Available in the Text. Standardized phenotypes for visual and anatomical response to anti-VEGF treatment for center-involved diabetic macular edema were developed from three DRCR Retina Network randomized clinical trials. These phenotypes are suitable for identifying predictive biomarkers for response to anti-VEGF treatment and might facilitate comparison of treatment response among diverse cohorts with DME. Abstract : Background/Purpose: To define "strong" versus "weak" antivascular endothelial growth factor (anti-VEGF) treatment response in eyes with center-involved diabetic macular edema (CI-DME). Methods: Exploratory analyses of three DRCR Retina Network randomized trials of eyes with CI-DME treated with aflibercept, bevacizumab, or ranibizumab. Thresholds of 5-, 10-, and 15-letter gain defined strong visual acuity (VA) response when baseline VA was 20/25–20/32, 20/40–20/63, or 20/80–20/320, respectively. Thresholds of 50, 100, or 200- µ m reduction defined strong anatomical response when baseline central subfield thickness (CST) was <75, ≥75 to <175, or ≥175- µ m above standard thresholds. Additional thresholds from regression equations were calculated. Results: At 24 weeks, outcomes for strong response were achieved by 476 of 958 eyes (50%) for VA and 505 eyes (53%) for CST. At 104 weeks among the 32% of eyes with strong VA and CST response at 24 weeks, 195 of 281 (69%) maintained strong VA and CST response, whereas 20 (7%) had neither strong VA nor strong CST response. Outcomes rates were similar across protocols and when defined using regression equations. Conclusion: These phenotypes are suitable for efforts to identify predictive biomarkers for response to anti-VEGF therapy for DME and might facilitate comparison of treatment response among diverse cohorts with DME.