Do Higher Doses of Anti-VEGF Drugs Improve Efficacy in Diabetic Macular Edema?

This article is part of MPR’s coverage of the American Academy of Ophthalmology 2019 Meeting, taking place in San Francisco, CA. Our staff will report on medical research related to eye disorders, conducted by experts in the field. Check back regularly for more news from AAO 2019.

SAN FRANCISCO – Higher doses of vascular endothelial growth factor (VEGF) inhibitors provided no additional benefits in patients with diabetic macular edema (DME), according to research presented at the American Academy of Ophthalmology (AAO) 2019 Annual Meeting, held October 12-15, 2019 in San Francisco, California.

To determine if higher doses of anti-VEGF therapies were associated with improved outcomes in DME, investigators examined visual and anatomic responses in clinical trials that evaluated ≥2 doses of anti-VEGF in the same dosing regimen. Four trials were assessed, including the RESOLVE (NCT00284050), READ-3 (NCT01077401), and RIDE/RISE (NCT00473382/NCT00473330) studies for ranibizumab and the DA VINCI (NCT00789477) study for aflibercept. 

The authors found that higher doses of the anti-VEGF therapies ranibizumab and aflibercept did not provide consistent benefit compared to lower doses. For ranibizumab, doses up to 2mg did not provide better outcomes vs the indicated 0.3mg dose for DME. The DA VINCI trial for aflibercept found no additional benefit for the 2mg dose compared with the 0.5mg dose, however, the study was not powered to detect differences between the doses. 

“Across trials, anti-VEGF treatment resulted in meaningful improvements in patients with DME regardless of dose. Within trials, doubling or quadrupling doses did not seem to provide additional benefits,” the authors concluded.

Ranibizumab (Lucentis; Genentech) and aflibercept (Eylea; Regeneron) are intravitreal VEGF inhibitors indicated for the treatment of DME. Additional indications for both drugs include neovascular (wet) age-related macular degeneration (AMD), macular edema following retinal vein occlusion (RVO), and diabetic retinopathy (DR). Ranibizumab has an additional indication for the treatment of myopic choroidal neovascularization (mCNV). 

Reference

Do DV, Sepah YJ, Ecoiffier T, et al. High-dose anti-VEGF: Cross-trial analysis of different doses and antagonists for the treatment of DME. Presented at: The American Academy of Ophthalmology (AAO) 2019 Annual Meeting; October 12-15, 2019; San Francisco, California. Abstract PO457.