Outcomes of a 2-year treat-and-extend regimen with aflibercept for diabetic macular edema

Takao Hirano,Akihiro Ishibazawa,Shigeo Yoshida,Toshinori Murata,Michiyuki Saito,Masahiko Sugimoto,Yoshihiro Takamura,Yuichi Toriyama,Fumiki Okamoto,Kousuke Noda,Osamu Sawada,Taiji Nagaoka,Yoshimi Sugiura

doi:10.1038/s41598-021-83811-y

Abstract

This prospective, open-label, single-arm, non-randomized clinical trial, assessed the efficacy of a 2-year treat-and-extend (T&E) regimen involving intravitreal aflibercept injection (IAI), with the longest treatment interval set to 16 weeks, and adjunct focal/grid laser in diabetic macula edema (DME) patients. We examined 40 eyes (40 adults) with fovea-involving DME from 8 Japanese centers between April 2015 and February 2017. Participants received IAI with an induction period featuring monthly injections and a subsequent T&E period featuring 8–16-week injection interval, adjusted based on optical coherence tomography findings. The primary endpoints were mean changes in the best-corrected visual acuity (BCVA) and central subfield macular thickness (CST) from baseline. Thirty patients (75%) completed the 2-year follow-up. The mean BCVA and CST changed from 60.5 ± 15.6 letters and 499.2 ± 105.6 µm at baseline to 66.6 ± 17.1 letters (P = 0.217) and 315.2 ± 79.0 µm (P < 0.001), respectively, after 2 years. The treatment interval was extended to 12 and 16 weeks in 6.7% and 66.7% of patients, respectively, at the end of 2 years. The T&E aflibercept regimen with the longest treatment interval set to 16 weeks, with adjunct focal/grid laser may be a rational 2-year treatment strategy for DME.

Highlights

This prospective, open-label, single-arm, non-randomized clinical trial, assessed the efficacy of a 2-year treat-and-extend (T&E) regimen involving intravitreal aflibercept injection (IAI), with the longest treatment interval set to 16 weeks, and adjunct focal/grid laser in diabetic macula edema (DME) patients
The ALTAIR study that examined a T&E regimen with aflibercept for AMD reported that up to week 96, the injection interval was extended to 16 weeks for 46.3% patients in the group with 4-week a djustments[23]
We hypothesized that T&E regimens with aflibercept may extend the injection intervals to longer than 12 weeks, which should further reduce the number of injections

Summary

Introduction

This prospective, open-label, single-arm, non-randomized clinical trial, assessed the efficacy of a 2-year treat-and-extend (T&E) regimen involving intravitreal aflibercept injection (IAI), with the longest treatment interval set to 16 weeks, and adjunct focal/grid laser in diabetic macula edema (DME) patients. The T&E aflibercept regimen with the longest treatment interval set to 16 weeks, with adjunct focal/grid laser may be a rational 2-year treatment strategy for DME. The financial costs of multiple anti-VEGF injections are sometimes not affordable for patients with DME, especially, after the second or third year, which can lead to deterioration in Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita, Sapporo 060‐8638, Japan. Combined therapy with anti-VEGF injections and other conventional treatments, such as focal/grid laser[14,15], and corticosteroids[16] has demonstrated modest effects in reducing the required number of injections compared with monotherapy. We hypothesized that T&E regimens with aflibercept may extend the injection intervals to longer than 12 weeks, which should further reduce the number of injections

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Conclusion