San Diego - Patients with diabetic macularedema (DMO) receive fewer intravitreal anti-VEGF injections in clinical practice than in published clinical trials, so that their visual acuity is improved to a lesser extent.
Nancy M. Holekamp, MD, and her colleagues examined large national databases to establish the practice of real treatment for diabetic macular edema, and found that patients received 2-3 anti-VEGF injections for a 12-month period.
"This is much lower than the monthly dose that weseen in the studies of RIDE and RISE. This is even less than nine injections per person on average in the BOLT study, "said Holakamp at the annual meeting of the American Society of Retina Experts.
In a subsequent analysis of electronic medicaldata records from a large health care system in Pennsylvania, Holecamp and her colleagues found that 75% of patients received three or fewer injections to treat DMO for 12 months. When studying 94 eyes, it turned out that the improvement in visual acuity in comparison with the initial one averaged four letters on the table for 6 months and 1.9 - 3.7 letters for 12 months. For comparison, patients in the RIDE and RISE studies added 11.4 letters and 10.5 letters, respectively.
"We knew before that patients who were made2-3 injections over a 12-month period are likely to be under-treated. But this study shows for the first time that these patients also experience less improvement in visual acuity, "said Holakamp.
Such an injection paradigm will be difficultchange due to the large overall burden of visiting doctors' offices in this population group, she said, adding that longer-term effective treatment is necessary to achieve better visual acuity with fewer injections.