By Dennis Thompson Health Day Reporter
WEDNESDAY, March 31, 2021 (HealthDay News) — The overall eye health of people with diabetes benefits from preventive injections of medication directly into the eyeball, but it’s too early to tell whether such treatment will better preserve their long-term vision. , new clinical studies trial results show.
Regular injections of aflibercept (Eylea) caused a more than three-fold reduction in blood vessel leakage inside the retina and a more than two-fold reduction in abnormal blood vessel growth in the retina, reported researchers. The study was supported by the National Eye Institute, part of the US National Institutes of Health, and published March 30 in JAMA Ophthalmology.
But over two years, patients who received preventative injections of the drug performed no better on vision tests than others who only received treatment once they started losing their sight. , showed the results.
“Based on these results, some physicians will choose to treat early because they believe it is important to prevent the development of complications,” said lead researcher Dr. Jennifer Sun, head of research and clinical trials at eyes at the Joslin Diabetes Center at Harvard Medical School in Boston. . “Other doctors will think that even if we prevent complications, if there is no major difference in vision, we might as well wait and not expose the patient to the cost, burden and risks of treatment. .”
Diabetic retinopathy is the most common cause of vision loss in people with diabetes. It happens when blood vessels swell and leak in the retina, the light-sensitive layer at the back of the eye that receives and transmits visual signals to the brain.
Drugs that inhibit blood vessel growth – anti-vascular endothelial growth factor (anti-VEGF) drugs – such as Eylea are considered the “gold standard” for treating diabetic retinopathy, Sun said. .
“Before these drugs were available, all we really had was the laser. It was the standard of care for many years. It could certainly slow the progression of the disease, but very often there was no improvement,” said retina specialist Dr. Richard Rosen. specialist at the New York Eye and Ear Infirmary of Mount Sinai in New York.
“These drugs saved vision and allowed people to carry on in a more normal way. It’s really a huge step forward,” said Rosen, who was not part of the study.
But the question remains whether people with diabetes would benefit from preventive treatment with anti-VEGF drugs in the early stages of retinopathy, when changes in the blood vessels of the eye are visible to doctors but have not yet affected a person’s eyesight.
In this study, 200 eyes with early onset diabetic retinopathy received regular injections of Eylea, while another 199 eyes were treated with a placebo. The injections were given once a month initially, but eventually changed to once every four months.
If their diabetic retinopathy progressed, people in the placebo group started receiving injections of Eylea to treat their disease.
Over two years, the rate of development of proliferative diabetic retinopathy – the late stage of the disease when new blood vessels invade the retina – was 33% in the placebo group and 14% in the treatment group.
The rate of leaking blood vessels affecting vision was 15% in the placebo group and 4% in the Eylea group.
Vision loss was essentially the same in both groups.
“What this study tells us is that over two years, if you don’t treat immediately but treat if complications develop, visual outcomes on average are still excellent,” Sun said.
The open question is whether preventing these complications in the first place will save vision later. Sun and his colleagues will follow the patients for four years to track their progress.
Anti-VEGF drugs like Eylea are expensive, costing $1,000 to $2,000 per dose, and patients face rare side effects such as eyeball infections, Sun said. It might not be worth the money or the health risk to provide preventative treatment.
“When you’re talking about a drug being given very frequently, that’s a huge cost to public health,” Sun said.
On the other hand, doctors could better preserve patients’ sight if they tackle eye problems head-on.
“The idea that you can prevent disease progression in patients is very important and makes a lot of sense,” Rosen said. “It takes many years to develop diabetic retinopathy, but very often there are things that happen to people with this condition that are unforeseen and unforeseen. Anything you can do to control the progression of the disease from the onset makes very good clinical sense.”
SOURCES: Jennifer Sun, MD, MPH, ophthalmologist, chief, eye research and clinical trials, Joslin Diabetes Center, Harvard Medical School, Boston; Richard Rosen, MD, retina specialist, New York Eye and Ear Infirmary of Mount Sinai, New York City; JAMA Ophthalmology, March 30, 2021
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