ADA: Restoring Visual Acuity in Diabetes with VEGF Inhibitor

The vascular endothelial growth factor (VEGF) inhibitor ranibizumab (Lucentis) proves promising in treating diabetic macular edema….

According to the analysis of data from the RIDE and RISE trials, intravitreal injections of ranibizumab, a vascular endothelial growth factor (VEGF) inhibitor, doubled or tripled the proportion of patients with diabetic macular edema who experienced improved visual acuity (as evidenced by regaining three lines on the eye chart) compared with placebo. Standard of care in diabetic macular edema has traditionally been laser photocoagulation, which stabilizes vision but doesn’t necessarily restore visual acuity.

In more than 60% of patients treated with ranibizumab, vision improved from the baseline average of 20/80 to 20/40, the visual acuity needed to drive.

Patients received 24 months of intravitreal injections with placebo or ranibizumab and were eligible to receive rescue laser treatments at three months. The rescue treatments used to stabilize vision were used by three quarters of patients treated with placebo, but only in approximately 20-40% of those patients treated with ranibizumab.

Prior studies from the Diabetic Retinopathy Clinical Research Network have also found ranibizumab to be effective in improving visual acuity. The RIDE and RISE trials were designed to elicit FDA approval of ranibizumab for an indication of DME.

Patients treated with ranibizumab also experienced improvement in function, as they scored higher on the National Eye Institute Visual Function Questionnaire compared to those treated with placebo. Improvements were also seen in central foveal thickness, as well as lessening severity of diabetic retinopathy.

Treatment with ranibizumab injections can be costly and are often not covered by insurance. Clinicians have been extrapolating the results to another, more cost-effective anti-VEFG drug bevacizumab (Avastin) based on the results from the CATT study which found that bevacizumab and ranibizumab blocked the same isoform of VEGF.

ADA 71st Scientific Meeting (132-LBOR ); June 28, 2011